Individual
MOLLY BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1585 3RD ST, FORT POLK, LA 71459-5102
(210) 862-9692
Mailing address
43 BASSETT ST, FORT BRAGG, NC 28307-2032
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
10041796
OR
367500000X
Certified Registered Nurse Anesthetist
Primary
971137
TX
Other
Enumeration date
11/10/2020
Last updated
07/08/2025
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