Individual
MRS. MOLLY JEAN NOTBOHM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
12311 PERRY HWY, WEXFORD, PA 15090-8344
(878) 332-4387
(412) 332-4490
Mailing address
12311 PERRY HWY, WEXFORD, PA 15090-8344
(878) 332-4387
(412) 332-4490
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA055861
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103162687
—
PA
01
—
12482518
CAQH
—
Enumeration date
11/15/2012
Last updated
02/03/2022
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