Individual
MOLLY REQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3831 PIPER STREET STE S450, ANCHORAGE, AK 99508
(907) 258-6999
(907) 258-6247
Mailing address
3831 PIPER STREET STE S450, ANCHORAGE, AK 99508
(907) 258-6999
(907) 258-6247
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
157014
AK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1706117
—
AK
Enumeration date
09/10/2018
Last updated
11/05/2020
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