Individual
MS. MOLLYROSE M WANNAMAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
234 GOODMAN ST, CINCINNATI, OH 45219
(513) 475-8787
(513) 475-7348
Mailing address
289 OLMSTED BLVD, STE 5, PINEHURST, NC 28374-8730
(910) 420-1282
(910) 420-1116
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
0010-11376
NC
363AS0400X
Surgical Physician Assistant
1968
SC
363AS0400X
Surgical Physician Assistant
50005855RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1986
SC LICENSE
SC
05
—
379336601
—
TX
Enumeration date
09/08/2013
Last updated
12/22/2021
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