Provider Demographics
NPI:1386071314
Name:HUISMAN, MOLLY JO (RN, BSN)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:JO
Last Name:HUISMAN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:MOLLY JO
Other - Middle Name:HUISMAN
Other - Last Name:RECCHIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:10133 COLLEGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-8492
Mailing Address - Country:US
Mailing Address - Phone:423-645-1589
Mailing Address - Fax:
Practice Address - Street 1:921 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2102
Practice Address - Country:US
Practice Address - Phone:423-209-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN186178163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse