Basic Information
| Provider Information | |||||||||
| NPI: | 1700432689 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOLUA | ||||||||
| FirstName: | ESELLE | ||||||||
| MiddleName: | MATHIAS | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7112 SANDOWN CIR APT 303 | ||||||||
| Address2: | |||||||||
| City: | WINDSOR MILL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212447928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2406435232 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1447 YORK RD STE 506 | ||||||||
| Address2: | |||||||||
| City: | LUTHERVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210936022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108252281 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2019 | ||||||||
| LastUpdateDate: | 12/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/19/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | R215684 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.