Provider Demographics
NPI:1083342398
Name:HARRISON, MOLLY (LEC, PPD, NCS)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LEC, PPD, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 NE 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-3207
Mailing Address - Country:US
Mailing Address - Phone:985-264-7896
Mailing Address - Fax:
Practice Address - Street 1:4425 NE 62ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-3207
Practice Address - Country:US
Practice Address - Phone:985-264-7896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-13
Last Update Date:2022-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty