Provider Demographics
NPI:1003345893
Name:MOLLY CARR NP & HERBALIST LLC
Entity Type:Organization
Organization Name:MOLLY CARR NP & HERBALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:MS
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:FOOTE
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:301-284-0599
Mailing Address - Street 1:6106 HARVARD AVE, BOX 345
Mailing Address - Street 2:
Mailing Address - City:GLEN ECHO
Mailing Address - State:MD
Mailing Address - Zip Code:20812-9998
Mailing Address - Country:US
Mailing Address - Phone:301-284-0599
Mailing Address - Fax:
Practice Address - Street 1:438 N FREDERICK AVE STE 320
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2458
Practice Address - Country:US
Practice Address - Phone:240-631-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR112938305S00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305S00000XManaged Care OrganizationsPoint of ServiceGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD466702600Medicaid
1013225465OtherNPI ISSUED BY US GOV FOR MOLLY FOOTE CARR AS AN INDIVIDUAL PRACTITIONER