Provider Demographics
NPI:1235019308
Name:TRACY, MOLLY MARIE (RN)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:MARIE
Last Name:TRACY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4524
Mailing Address - Country:US
Mailing Address - Phone:207-872-7272
Mailing Address - Fax:207-872-0639
Practice Address - Street 1:40 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4524
Practice Address - Country:US
Practice Address - Phone:207-872-7272
Practice Address - Fax:207-872-0639
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN80017163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)