Provider Demographics
NPI:1588244891
Name:LAGREW, MOLLIE KATHRYN (MD)
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:KATHRYN
Last Name:LAGREW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MOLLIE
Other - Middle Name:KATHRYN
Other - Last Name:MANSFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 SW ARCHER ROAD
Mailing Address - Street 2:PO BOX 100277
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610
Mailing Address - Country:US
Mailing Address - Phone:352-265-0239
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-0239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-11
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program