Provider Demographics
NPI:1831906130
Name:WARREN, MOLLY DIPAOLA (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:DIPAOLA
Last Name:WARREN
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:ANN
Other - Last Name:DIPAOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:1022 GRAFTON WAY
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7013
Mailing Address - Country:US
Mailing Address - Phone:704-351-2461
Mailing Address - Fax:
Practice Address - Street 1:1022 GRAFTON WAY
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-7013
Practice Address - Country:US
Practice Address - Phone:704-351-2461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1178133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered