Individual
MRS. MOLLY SUSAN PHILLIPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.R.N.P.
Contact information
Practice address
2065 E 17TH ST, SUITE D, IDAHO FALLS, ID 83404-8042
(208) 522-0747
(208) 522-9641
Mailing address
2065 E 17TH ST, SUITE D, IDAHO FALLS, ID 83404-8042
(208) 522-0747
(208) 522-9641
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
NP320A
ID
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
NP320A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002352900
—
ID
Enumeration date
08/29/2006
Last updated
05/10/2013
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