Provider Demographics
NPI:1871233528
Name:TATELY, MOLLY (ND)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:
Last Name:TATELY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3343 N 62ND PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5415
Mailing Address - Country:US
Mailing Address - Phone:480-822-9072
Mailing Address - Fax:
Practice Address - Street 1:8040 E MORGAN TRL STE 1
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-1233
Practice Address - Country:US
Practice Address - Phone:480-426-8040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22-1708175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath