Provider Demographics
NPI:1700648052
Name:PRICE, MOLLY (NP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16952 AFRICA RD
Mailing Address - Street 2:
Mailing Address - City:THOMPSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62890-4525
Mailing Address - Country:US
Mailing Address - Phone:618-499-2815
Mailing Address - Fax:
Practice Address - Street 1:310 W PLAZA DR
Practice Address - Street 2:
Practice Address - City:CARTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62918-1980
Practice Address - Country:US
Practice Address - Phone:618-985-4344
Practice Address - Fax:833-991-3991
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.029018363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty