Basic Information
| Provider Information | |||||||||
| NPI: | 1417200726 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRUMLEY | ||||||||
| FirstName: | MOLLY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 FAIRFAX BLVD | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198033025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103064776 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1930 S BROAD ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191452328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153394563 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2012 | ||||||||
| LastUpdateDate: | 10/24/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WA2000X | RN329989L | PA | Y | Nursing Service Providers | Registered Nurse | Administrator |
No ID Information.