Provider Demographics
NPI:1225738198
Name:MOLLEMA, JENNA LEE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:LEE
Last Name:MOLLEMA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:WINDOM
Mailing Address - State:MN
Mailing Address - Zip Code:56101-1287
Mailing Address - Country:US
Mailing Address - Phone:507-831-2400
Mailing Address - Fax:
Practice Address - Street 1:2934 OAK AVE
Practice Address - Street 2:
Practice Address - City:SLAYTON
Practice Address - State:MN
Practice Address - Zip Code:56172-1434
Practice Address - Country:US
Practice Address - Phone:507-360-5258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN146N00000X
MN2466857163W00000X
MN11363363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No163W00000XNursing Service ProvidersRegistered Nurse