Provider Demographics
NPI:1679218424
Name:KIDNER, MOLLIE ELIZABETH
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:ELIZABETH
Last Name:KIDNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MOLLIE
Other - Middle Name:ELIZABETH
Other - Last Name:KISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:854 S MCCLELLAND RD
Mailing Address - Street 2:
Mailing Address - City:WHITE CLOUD
Mailing Address - State:MI
Mailing Address - Zip Code:49349-9733
Mailing Address - Country:US
Mailing Address - Phone:248-880-2069
Mailing Address - Fax:
Practice Address - Street 1:4473 220TH AVE
Practice Address - Street 2:
Practice Address - City:REED CITY
Practice Address - State:MI
Practice Address - Zip Code:49677-8593
Practice Address - Country:US
Practice Address - Phone:989-772-5930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health