| NPI | 1184060055 |
|---|---|
| Former Name | MOLLY MENNENGA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.141151) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125-062930) |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2016-07-08 |