Provider Demographics
NPI:1740430297
Name:DANISON, MOLLY LYNN (CPM)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:LYNN
Last Name:DANISON
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 ROLLINS ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-3720
Mailing Address - Country:US
Mailing Address - Phone:406-721-0265
Mailing Address - Fax:
Practice Address - Street 1:541 ROLLINS ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3720
Practice Address - Country:US
Practice Address - Phone:406-721-0265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-21
Last Update Date:2008-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife