Provider Demographics
NPI:1326042094
Name:BARTLETT, MOLLY (CRNP)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 RIDGELY AVE
Mailing Address - Street 2:STE 130
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1045
Mailing Address - Country:US
Mailing Address - Phone:410-266-8049
Mailing Address - Fax:410-266-0787
Practice Address - Street 1:600 RIDGELY AVE
Practice Address - Street 2:STE 130
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1045
Practice Address - Country:US
Practice Address - Phone:410-266-8049
Practice Address - Fax:410-266-0787
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2014-08-14
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
MDR086942174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
S81960Medicare UPIN