Provider Demographics
NPI:1376772475
Name:MOLL, CYNTHIA LEE (LPN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LEE
Last Name:MOLL
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 1:235 LINDEN PL
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43609-2546
Mailing Address - Country:US
Mailing Address - Phone:419-442-9384
Mailing Address - Fax:
Practice Address - Street 1:270 WALBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43609-2843
Practice Address - Country:US
Practice Address - Phone:419-260-6776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.116524MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse