Provider Demographics
NPI:1134317977
Name:STRAUB, MOLLY C (LMP)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:C
Last Name:STRAUB
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12579 C STREET BAYIEW
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273
Mailing Address - Country:US
Mailing Address - Phone:360-202-1356
Mailing Address - Fax:
Practice Address - Street 1:639 SUNSET PARK DR
Practice Address - Street 2:103
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-1540
Practice Address - Country:US
Practice Address - Phone:360-202-1356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020804174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist