Provider Demographics
NPI:1598946618
Name:MOLLISON, MARY F (CNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:F
Last Name:MOLLISON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9702 ACME RD
Mailing Address - Street 2:
Mailing Address - City:RITTMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44270-9623
Mailing Address - Country:US
Mailing Address - Phone:330-336-8737
Mailing Address - Fax:330-336-8747
Practice Address - Street 1:25 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RITTMAN
Practice Address - State:OH
Practice Address - Zip Code:44270-1914
Practice Address - Country:US
Practice Address - Phone:330-925-1500
Practice Address - Fax:330-925-9030
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN223716363LA2200X
OHNP-06992363LA2200X
OHNS-05805364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health