Provider Demographics
NPI:1477815785
Name:MOLIEN, KETSIA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:KETSIA
Middle Name:
Last Name:MOLIEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18501 HILLSIDE AVE APT 4E
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4801
Mailing Address - Country:US
Mailing Address - Phone:347-248-0248
Mailing Address - Fax:
Practice Address - Street 1:18501 HILLSIDE AVE APT 4E
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4801
Practice Address - Country:US
Practice Address - Phone:347-248-0248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295208-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse