1871700872 NPI number — MS. STEPHANIE ELLEN MOLL CFA

Table of content: MR. MICAH J BENSON PA-C (NPI 1437464153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871700872 NPI number — MS. STEPHANIE ELLEN MOLL CFA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOLL
Provider First Name:
STEPHANIE
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CFA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871700872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 714
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TONOPAH
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85354-0714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-393-8325
Provider Business Mailing Address Fax Number:
623-327-1903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1603 SO. 389TH AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TONOPAH
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-393-8325
Provider Business Practice Location Address Fax Number:
623-327-1903
Provider Enumeration Date:
05/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
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Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)