Provider Demographics
NPI:1639238652
Name:ROTHMEYER, MOLLY K (ARNP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:K
Last Name:ROTHMEYER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 REASONER RD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1517
Mailing Address - Country:US
Mailing Address - Phone:253-683-9754
Mailing Address - Fax:
Practice Address - Street 1:1887 MAKUAKANE ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1887
Practice Address - Country:US
Practice Address - Phone:808-842-8211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2023-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007292363LF0000X
HIAPRN-3836363LF0000X, 363LP0222X
AKNURU1458363LF0000X, 363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9648833Medicaid