Provider Demographics
NPI:1982974846
Name:WALLACE-WELCH, MOLLY SUE (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:SUE
Last Name:WALLACE-WELCH
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:NY
Mailing Address - Zip Code:14892-1207
Mailing Address - Country:US
Mailing Address - Phone:607-565-2841
Mailing Address - Fax:607-565-4997
Practice Address - Street 1:1 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:NY
Practice Address - Zip Code:14892-1207
Practice Address - Country:US
Practice Address - Phone:607-565-2841
Practice Address - Fax:607-565-4997
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY489985163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool