Provider Demographics
NPI:1407279136
Name:MOLINA, JOANN MARIE
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:MARIE
Last Name:MOLINA
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 1:4922 W DESERT COVE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-4329
Mailing Address - Country:US
Mailing Address - Phone:623-570-1534
Mailing Address - Fax:
Practice Address - Street 1:4922 W DESERT COVE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-4329
Practice Address - Country:US
Practice Address - Phone:623-570-1534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP045652164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse