Provider Demographics
NPI:1942020755
Name:DEGROH, MOLLY BRADISH (FNP-C)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:BRADISH
Last Name:DEGROH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 N OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-4926
Mailing Address - Country:US
Mailing Address - Phone:847-830-4476
Mailing Address - Fax:
Practice Address - Street 1:808 N OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4926
Practice Address - Country:US
Practice Address - Phone:847-830-4476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209030726363LF0000X
IL209.030726363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care