Provider Demographics
NPI:1629331459
Name:MOLENKAMP, JOANN ADRIANA (RN)
Entity Type:Individual
Prefix:MS
First Name:JOANN
Middle Name:ADRIANA
Last Name:MOLENKAMP
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 THELOSEN DR
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:WI
Mailing Address - Zip Code:54136-2336
Mailing Address - Country:US
Mailing Address - Phone:920-205-7009
Mailing Address - Fax:
Practice Address - Street 1:702 THELOSEN DR
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:WI
Practice Address - Zip Code:54136-2336
Practice Address - Country:US
Practice Address - Phone:920-205-7009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI128489-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse