Provider Demographics
NPI:1578872479
Name:SCROGGIN, MOLLIE (LPN)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:SCROGGIN
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 1:813 WALTON CT
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:OH
Mailing Address - Zip Code:45067-1476
Mailing Address - Country:US
Mailing Address - Phone:513-468-4079
Mailing Address - Fax:
Practice Address - Street 1:813 WALTON CT
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:OH
Practice Address - Zip Code:45067-1476
Practice Address - Country:US
Practice Address - Phone:513-468-4079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH129059-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse