Provider Demographics
NPI:1871926808
Name:EWING, MOLLIE K (RN)
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:K
Last Name:EWING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MOLLIE
Other - Middle Name:K
Other - Last Name:MISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:301 RANDOLPH ST
Mailing Address - Street 2:PO BOX 660
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-0660
Mailing Address - Country:US
Mailing Address - Phone:410-479-4306
Mailing Address - Fax:410-479-1714
Practice Address - Street 1:609 DAFFIN LANE
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-1392
Practice Address - Country:US
Practice Address - Phone:410-479-2650
Practice Address - Fax:410-479-1626
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR182077163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator