Provider Demographics
NPI:1750797676
Name:ANDERSON, MOLLY LENHART (PA-C)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:LENHART
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:ANN
Other - Last Name:LENHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0012
Mailing Address - Country:US
Mailing Address - Phone:406-327-7000
Mailing Address - Fax:406-329-1927
Practice Address - Street 1:3055 N RESERVE ST STE D
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1395
Practice Address - Country:US
Practice Address - Phone:406-327-7000
Practice Address - Fax:406-329-1927
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11657363A00000X
MTMED-PAC-LIC-102568363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant