Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | Q8572 | TX |
Y | 2080P0203X | Pediatric Critical Care Doctor | Q8572 | TX |
NPI | 1245599133 |
---|---|
Provider Name | Wallis Anne Molchen |
First Address | Houston, TX 77021-2039 |
Second Address | Houston, TX 77030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2012 |
Last Update Date | 23/07/2018 |