Provider Demographics
NPI:1053932871
Name:NUERNBERGER, MOLLY KAE (LPN)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:KAE
Last Name:NUERNBERGER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1982 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:WEST FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14170-9631
Mailing Address - Country:US
Mailing Address - Phone:716-220-5266
Mailing Address - Fax:
Practice Address - Street 1:1982 DAVIS RD
Practice Address - Street 2:
Practice Address - City:WEST FALLS
Practice Address - State:NY
Practice Address - Zip Code:14170-9631
Practice Address - Country:US
Practice Address - Phone:716-220-5266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313179-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse