Provider Demographics
NPI:1407255086
Name:BABL, MOLLY RUTH (PA-C)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:RUTH
Last Name:BABL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:RUTH
Other - Last Name:TRAUERNICHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 S 48TH ST STE 412
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1278
Mailing Address - Country:US
Mailing Address - Phone:402-483-8686
Mailing Address - Fax:402-481-0178
Practice Address - Street 1:1500 S 48TH ST STE 412
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1278
Practice Address - Country:US
Practice Address - Phone:402-483-8686
Practice Address - Fax:402-481-0178
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2853363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty