Provider Demographics
NPI:1578734927
Name:FREELY, MOLLY ELIZABETH (APN)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:ELIZABETH
Last Name:FREELY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:ELIZABETH
Other - Last Name:GODWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 S WILKE RD STE 606
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1529
Mailing Address - Country:US
Mailing Address - Phone:847-749-2248
Mailing Address - Fax:847-259-8209
Practice Address - Street 1:121 S WILKE RD STE 605
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005
Practice Address - Country:US
Practice Address - Phone:847-749-2248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006669363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics