Provider Demographics
NPI:1497321277
Name:YAZMAN, MOLLY (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:YAZMAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 GRISTMILL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-7201
Mailing Address - Country:US
Mailing Address - Phone:540-271-2627
Mailing Address - Fax:
Practice Address - Street 1:199 SPOTNAP RD STE 4
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8827
Practice Address - Country:US
Practice Address - Phone:540-271-2627
Practice Address - Fax:434-995-5620
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPROVISIONAL363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty