Provider Demographics
NPI:1891538849
Name:JONES, MOLLY ELIZABETH-NOBACH
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:ELIZABETH-NOBACH
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9224 11TH PL NE UNIT B
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-3416
Mailing Address - Country:US
Mailing Address - Phone:425-328-4446
Mailing Address - Fax:
Practice Address - Street 1:12506 18TH ST NE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-8145
Practice Address - Country:US
Practice Address - Phone:425-328-4446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61497482225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist