Provider Demographics
NPI:1770393605
Name:WEIR, MOLLY
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:WEIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 ROCK LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WARD
Mailing Address - State:CO
Mailing Address - Zip Code:80481-9518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1209 ROCK LAKE RD
Practice Address - Street 2:
Practice Address - City:WARD
Practice Address - State:CO
Practice Address - Zip Code:80481-9518
Practice Address - Country:US
Practice Address - Phone:616-550-1846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant