Provider Demographics
NPI:1649606278
Name:CORUM, MOLLY MARIE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:MARIE
Last Name:CORUM
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:MARIE
Other - Last Name:MCCAUGHEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3050 MACK ROAD
Mailing Address - Street 2:MLC 11032
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5379
Mailing Address - Country:US
Mailing Address - Phone:513-636-8259
Mailing Address - Fax:513-636-6419
Practice Address - Street 1:3050 MACK ROAD
Practice Address - Street 2:MLC 11032
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5379
Practice Address - Country:US
Practice Address - Phone:513-636-8259
Practice Address - Fax:513-636-6419
Is Sole Proprietor?:No
Enumeration Date:2013-09-14
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.14896363L00000X
OHCOA14896NP363LP0200X
PASP016635363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics