Provider Demographics
NPI:1003056565
Name:MOLTON, SONNJA MICHELLE
Entity Type:Individual
Prefix:MS
First Name:SONNJA
Middle Name:MICHELLE
Last Name:MOLTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 E 147TH ST
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-3732
Mailing Address - Country:US
Mailing Address - Phone:216-970-6879
Mailing Address - Fax:
Practice Address - Street 1:944 E 147TH ST
Practice Address - Street 2:APARTMENT 1
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-3732
Practice Address - Country:US
Practice Address - Phone:216-970-6879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHC1222OtherOHIO CHOICE DEMONSTRATION PROGRAM
OH2878604Medicaid