Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 71004729A | IN |
NPI | 1073952495 |
---|---|
Provider Name | Maria C Molter |
First Address | Muncie, IN 47303-4988 |
Second Address | Lafayette, IN 47905-8764 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2013 |
Last Update Date | 27/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000872940 | ANTHEM PROVIDER NUMBER (01) | IN |
201220530 | (05) | IN |