Provider Demographics
NPI:1174295703
Name:SULTENFUSS, MOLLIE FRANCES
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:FRANCES
Last Name:SULTENFUSS
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 1:985450 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-5450
Mailing Address - Country:US
Mailing Address - Phone:402-559-6580
Mailing Address - Fax:402-559-5737
Practice Address - Street 1:6902 PINE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2855
Practice Address - Country:US
Practice Address - Phone:402-559-6580
Practice Address - Fax:402-559-5737
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2599225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist