Provider Demographics
NPI:1962739656
Name:MOLLARD, ELIZABETH K (CNM, WHNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:MOLLARD
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8020 O ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2561
Mailing Address - Country:US
Mailing Address - Phone:402-488-6370
Mailing Address - Fax:402-488-4393
Practice Address - Street 1:8020 O ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2561
Practice Address - Country:US
Practice Address - Phone:402-488-6370
Practice Address - Fax:402-488-4393
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111107363L00000X
NE120083367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner