Provider Demographics
NPI:1326745241
Name:ANDERSON, MOLLY (FNP-C)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:MAGOVERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:101 E PLUMMER BLVD
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-8047
Mailing Address - Country:US
Mailing Address - Phone:217-483-3487
Mailing Address - Fax:217-483-8150
Practice Address - Street 1:101 E PLUMMER BLVD
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-8047
Practice Address - Country:US
Practice Address - Phone:217-483-3487
Practice Address - Fax:217-483-8150
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209031473363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041.580100OtherIL RN LICENSE
VA30017582240003Medicaid