Provider Demographics
NPI:1336971589
Name:VANDERWERFF, MOLLY (RN BSN)
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:
Last Name:VANDERWERFF
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:DACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN BSN
Mailing Address - Street 1:9 KOENIG CT
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1306
Mailing Address - Country:US
Mailing Address - Phone:315-515-9581
Mailing Address - Fax:
Practice Address - Street 1:144 GENESEE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3503
Practice Address - Country:US
Practice Address - Phone:315-253-8477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY797464-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse