Provider Demographics
NPI:1598135816
Name:MCDONNELL, MOLLY
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:MCDONNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 HARVARD AVE E
Mailing Address - Street 2:APT. 201
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-4931
Mailing Address - Country:US
Mailing Address - Phone:360-521-6951
Mailing Address - Fax:
Practice Address - Street 1:611 HARVARD AVE E
Practice Address - Street 2:APT. 201
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-4931
Practice Address - Country:US
Practice Address - Phone:360-521-6951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60605298363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health