Provider Demographics
NPI:1578388294
Name:NICHOLSON, MOLLY (APRN, CNM)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:NICHOLSON
Suffix:
Gender:
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 COMMONS LOOP STE A
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-1919
Mailing Address - Country:US
Mailing Address - Phone:406-858-8009
Mailing Address - Fax:406-272-1655
Practice Address - Street 1:165 COMMONS LOOP STE A
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-1919
Practice Address - Country:US
Practice Address - Phone:406-858-8009
Practice Address - Fax:406-272-1655
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT249651363L00000X
MTNUR-APRN-LIC-249651367A00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife