Provider Demographics
NPI:1669629713
Name:GILMORE, MOLLY LOUVNIA (CNA)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:LOUVNIA
Last Name:GILMORE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-0785
Mailing Address - Country:US
Mailing Address - Phone:240-305-7191
Mailing Address - Fax:301-877-2546
Practice Address - Street 1:8103 JENNI AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2218
Practice Address - Country:US
Practice Address - Phone:240-305-7191
Practice Address - Fax:301-877-2546
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00040639171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor