Provider Demographics
NPI:1720471808
Name:THOMASON, MOLLY MISHLER (MA, MS)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:MISHLER
Last Name:THOMASON
Suffix:
Gender:F
Credentials:MA, MS
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:THERESA
Other - Last Name:MISHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:870 GANNON DR
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-2316
Mailing Address - Country:US
Mailing Address - Phone:847-208-1183
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:MSC09 5030
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:847-208-1183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program