Provider Demographics
NPI:1215497805
Name:OATEN, MOLLY (WHNP-BC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:OATEN
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 FAIRSTED DR APT 416
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4566
Mailing Address - Country:US
Mailing Address - Phone:203-444-0330
Mailing Address - Fax:
Practice Address - Street 1:2296 OPITZ BLVD STE 440
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3355
Practice Address - Country:US
Practice Address - Phone:703-878-0740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC300912163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty