Provider Demographics
NPI:1215987318
Name:MOLANO, NELLY (CRNP)
Entity type:Individual
Prefix:
First Name:NELLY
Middle Name:
Last Name:MOLANO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 DENISE DR APT E
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-2989
Mailing Address - Country:US
Mailing Address - Phone:410-733-3607
Mailing Address - Fax:
Practice Address - Street 1:1622 DENISE DR APT E
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2989
Practice Address - Country:US
Practice Address - Phone:410-733-3607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339007363L00000X
MDR140445363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD699414800Medicaid
MD699414800Medicaid
MDP45010Medicare UPIN