MEDICARE: LAURA MOLYNEAUX RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1922304435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MOLYNEAUX RN

Provider Business Mailing Address
First Line	:	27176 HAGGERTY ROAD
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48377
Country	:	US
Telephone Number	:	248-799-8300
Fax Number	:

Provider Business Practice Location Address
First Line	:	27175 HAGGERTY RD
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48377-3626
Country	:	US
Telephone Number	:	248-799-8303
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2011
Last Update Date	:	10/19/2016

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