Provider Demographics
NPI:1811659394
Name:ROLEN, MOLLY (MSN, FNP-BC, CCRP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:ROLEN
Suffix:
Gender:F
Credentials:MSN, FNP-BC, CCRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 CECILIA DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-1811
Mailing Address - Country:US
Mailing Address - Phone:901-413-3737
Mailing Address - Fax:
Practice Address - Street 1:294 CECILIA DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-1811
Practice Address - Country:US
Practice Address - Phone:901-413-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN212006163WG0000X
TN31230363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN212006OtherTN BOARD OF NURSING