Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | R74107 | AZ |
NPI | 1558701987 |
---|---|
Provider Name | Molly Christine Wormley |
First Address | Indianapolis, IN 46260-1330 |
Second Address | Indianapolis, IN 46260 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2013 |
Last Update Date | 24/06/2018 |