Individual
MOLLY REBECCA IDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
700 S PARK ST, MADISON, WI 53715-1830
(608) 251-6000
(608) 258-5222
Mailing address
4620 FREY ST APT 327, MADISON, WI 53705-2903
(608) 577-5563
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
14096
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831875251
—
WI
Enumeration date
06/22/2023
Last updated
08/30/2023
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