Basic Information
| Provider Information | |||||||||
| NPI: | 1205834116 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUIR | ||||||||
| FirstName: | MOLLY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44405 WOODWARD AVE STE A | ||||||||
| Address2: | |||||||||
| City: | PONTIAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483415023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488583000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1794 N LAPEER RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LAPEER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484467664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8109694501 | ||||||||
| FaxNumber: | 8109694407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2005 | ||||||||
| LastUpdateDate: | 04/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 4704212262 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 05225 | 01 | OH | PARAMOUNT | OTHER | 344428256 | 01 | OH | FRONTPATH | OTHER | 344428256087 | 01 | OH | CARESOURCE | OTHER | 000000356101 | 01 | OH | ANTHEM | OTHER | 2528545 | 05 | OH | MEDICAID | 344428256 | 01 | OH | BEECHSTREET | OTHER | 4638608 | 05 | MI | MEDICAID | 4638617 | 05 | MI | MEDICAID |