Provider Demographics
NPI:1518292853
Name:MOLEN, JAMES BRADFORD (RN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BRADFORD
Last Name:MOLEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 N 220 E
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:UT
Mailing Address - Zip Code:84325-9707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:561 N 220 E
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:UT
Practice Address - Zip Code:84325-9707
Practice Address - Country:US
Practice Address - Phone:435-760-5653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT60273863102286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital