Provider Demographics
NPI:1013015163
Name:MCINTYRE, MOLLY (CNP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:CNP
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Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR
Mailing Address - Street 2:PO BOX 0446 LOBBY J
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:49650 CHERRY HILL RD
Practice Address - Street 2:SUITE 210
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-4849
Practice Address - Country:US
Practice Address - Phone:734-398-7899
Practice Address - Fax:734-398-7895
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-01-02
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Provider Licenses
StateLicense IDTaxonomies
MI4704211863363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics