Provider Demographics
NPI:1528363843
Name:MORAN, MOLLY DELORES (CRNP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:DELORES
Last Name:MORAN
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 1:915 BISHOP WALSH RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1805
Mailing Address - Country:US
Mailing Address - Phone:301-777-2722
Mailing Address - Fax:301-777-1106
Practice Address - Street 1:915 BISHOP WALSH RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1805
Practice Address - Country:US
Practice Address - Phone:301-777-2722
Practice Address - Fax:301-777-1106
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR151012363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics