Provider Demographics
NPI:1467970053
Name:JOHNSON, MOLLY AMANDA
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:AMANDA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:AMANDA
Other - Last Name:CAPPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:161 RABBIT HOLW
Mailing Address - Street 2:
Mailing Address - City:DIBOLL
Mailing Address - State:TX
Mailing Address - Zip Code:75941-3532
Mailing Address - Country:US
Mailing Address - Phone:936-215-9339
Mailing Address - Fax:
Practice Address - Street 1:161 RABBIT HOLW
Practice Address - Street 2:
Practice Address - City:DIBOLL
Practice Address - State:TX
Practice Address - Zip Code:75941-3532
Practice Address - Country:US
Practice Address - Phone:936-215-9339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-02
Last Update Date:2017-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula