Provider Demographics
NPI:1114694494
Name:OGREN, MOLLY J
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:J
Last Name:OGREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 COUNTY ROAD DM
Mailing Address - Street 2:
Mailing Address - City:MORRISONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53571-9510
Mailing Address - Country:US
Mailing Address - Phone:773-983-4898
Mailing Address - Fax:
Practice Address - Street 1:3142 VIEW RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-5949
Practice Address - Country:US
Practice Address - Phone:773-983-4898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider