Molly Lynn Anderson
Individual provider Active NPI Athletic Trainer · Macomb, IL
NPI 1407079429 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1407079429
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 1 University Cir
Western Illinois University
Macomb, IL 61455-1367 - Phone
- (309) 298-2135
- NPI assigned
- Apr 10, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 096001811 | IL | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | IL | Yes |
Addresses
Primary practice location
1 University Cir
Western Illinois University
Macomb, IL 61455-1367
Mailing address
630 S Johnson St
Macomb, IL 61455-2843
Phone (217) 316-6794
Other providers in Macomb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.