Provider Demographics
NPI:1861039778
Name:HABERMEYER, MOLLY MONACO (RN)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:MONACO
Last Name:HABERMEYER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:MONACO
Other - Last Name:PERRONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2139 TULIE TRL APT A
Mailing Address - Street 2:
Mailing Address - City:HOLLOMAN AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88330-7672
Mailing Address - Country:US
Mailing Address - Phone:719-209-2932
Mailing Address - Fax:
Practice Address - Street 1:1900 N WHITE SANDS BLVD
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6246
Practice Address - Country:US
Practice Address - Phone:575-439-4489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1628431163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool