Provider Demographics
NPI:1114572278
Name:MOLINA, MELISA J (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MELISA
Middle Name:J
Last Name:MOLINA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 IRON POINT RD
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-8707
Mailing Address - Country:US
Mailing Address - Phone:916-742-8569
Mailing Address - Fax:
Practice Address - Street 1:3701 J ST STE 201
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5542
Practice Address - Country:US
Practice Address - Phone:855-354-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012341363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner