Provider Demographics
NPI:1013180173
Name:MOLLY HENDERSON ARNP INC
Entity Type:Organization
Organization Name:MOLLY HENDERSON ARNP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-791-5933
Mailing Address - Street 1:1005 OLYMPIA AVE NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4033
Mailing Address - Country:US
Mailing Address - Phone:360-791-5933
Mailing Address - Fax:
Practice Address - Street 1:1005 OLYMPIA AVE NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4033
Practice Address - Country:US
Practice Address - Phone:360-791-5933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006528261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1471HEOtherREGENCE
WA301407471247HEOtherTRICARE
WA9629676Medicaid
WAP13463Medicare UPIN
WA9629676Medicaid