Provider Demographics
NPI:1801401492
Name:MOLBY, DENICE
Entity Type:Individual
Prefix:
First Name:DENICE
Middle Name:
Last Name:MOLBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7063 ENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5160
Mailing Address - Country:US
Mailing Address - Phone:440-487-8970
Mailing Address - Fax:
Practice Address - Street 1:7063 ENFIELD DR
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5160
Practice Address - Country:US
Practice Address - Phone:440-487-8970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4303195Medicaid