Provider Demographics
NPI:1215797618
Name:MOLT, LISA ANN (BSN, RN, CDCES)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:MOLT
Suffix:
Gender:F
Credentials:BSN, RN, CDCES
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:834 N SOCORA ST STE 4
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3729
Mailing Address - Country:US
Mailing Address - Phone:316-440-2802
Mailing Address - Fax:316-440-2809
Practice Address - Street 1:834 N SOCORA ST STE 4
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3729
Practice Address - Country:US
Practice Address - Phone:316-440-2802
Practice Address - Fax:316-440-2809
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS110430163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator