Provider Demographics
NPI:1427788470
Name:DALE, MOLLY ELIZABETH (CRNP-FAMILY)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:ELIZABETH
Last Name:DALE
Suffix:
Gender:F
Credentials:CRNP-FAMILY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10120 TEAL LN
Mailing Address - Street 2:
Mailing Address - City:DEAL ISLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21821-1507
Mailing Address - Country:US
Mailing Address - Phone:410-202-9941
Mailing Address - Fax:
Practice Address - Street 1:10120 TEAL LN
Practice Address - Street 2:
Practice Address - City:DEAL ISLAND
Practice Address - State:MD
Practice Address - Zip Code:21821-1507
Practice Address - Country:US
Practice Address - Phone:410-202-9941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR222703363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR222703OtherCRNP-FAMILY LICENSE