Individual
MOLLIE R PUTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CST
Contact information
Practice address
1345 UNITY PL, 210, LAFAYETTE, IN 47905-5760
(765) 446-5432
(765) 446-5431
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 449-2732
(765) 446-5317
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
114045
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
114045
CST LICENSE
IN
Enumeration date
07/27/2011
Last updated
08/13/2015
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