Provider Demographics
NPI:1114079076
Name:CLYMO, MOLLY A (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:A
Last Name:CLYMO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8499 JONES RD
Mailing Address - Street 2:
Mailing Address - City:COHOCTON
Mailing Address - State:NY
Mailing Address - Zip Code:14826
Mailing Address - Country:US
Mailing Address - Phone:607-324-9967
Mailing Address - Fax:
Practice Address - Street 1:8499 JONES RD
Practice Address - Street 2:
Practice Address - City:COHOCTON
Practice Address - State:NY
Practice Address - Zip Code:14826
Practice Address - Country:US
Practice Address - Phone:607-324-9967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2197871164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02192661Medicaid