Provider Demographics
NPI:1013225465
Name:CARR, MOLLY FOOTE (CRNP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:FOOTE
Last Name:CARR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Practice Address - Street 2:STE 320
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2458
Practice Address - Country:US
Practice Address - Phone:301-814-6317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2023-08-28
Deactivation Date:2017-10-04
Deactivation Code:
Reactivation Date:2017-10-20
Provider Licenses
StateLicense IDTaxonomies
MDR112938363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health