| NPI | 1255715926 |
|---|---|
| Former Name | MOLLY BAUSUM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R230282) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9324399) |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2020-04-27 |