Provider Demographics
NPI:1760544985
Name:MOLLOY, JUDITH K (APRN)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:K
Last Name:MOLLOY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 NEWGATE RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1534
Mailing Address - Country:US
Mailing Address - Phone:203-888-2554
Mailing Address - Fax:
Practice Address - Street 1:141 NEWGATE RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478-1534
Practice Address - Country:US
Practice Address - Phone:203-888-2554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002359364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist