Provider Demographics
NPI:1801518188
Name:BLOHM, MOLLY (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:BLOHM
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:GAPEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, IBCLC
Mailing Address - Street 1:120 W BROOKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-2516
Mailing Address - Country:US
Mailing Address - Phone:847-525-0729
Mailing Address - Fax:
Practice Address - Street 1:1950 W ROSCOE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1030
Practice Address - Country:US
Practice Address - Phone:847-525-0729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.394394163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant