Provider Demographics
NPI:1841728623
Name:ANDERSON, MOLLY A (PA)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:A
Other - Last Name:MULLERVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5055 A ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4970
Mailing Address - Country:US
Mailing Address - Phone:402-488-5600
Mailing Address - Fax:402-488-7649
Practice Address - Street 1:1405 RD 142, 71
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:WY
Practice Address - Zip Code:82060
Practice Address - Country:US
Practice Address - Phone:303-601-1139
Practice Address - Fax:402-488-7649
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2150207Y00000X
WY1120363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology