Provider Demographics
NPI:1568779692
Name:MOLINA, ANGELA MICHELE (LPN)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MICHELE
Last Name:MOLINA
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 1:50 CEDARHURST AVE.
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-3026
Mailing Address - Country:US
Mailing Address - Phone:631-835-8009
Mailing Address - Fax:
Practice Address - Street 1:50 CEDARHURST AVE.
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-3026
Practice Address - Country:US
Practice Address - Phone:631-835-8009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295370-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse