Provider Demographics
NPI:1750644241
Name:MOLINARI, KIMBERLY A (CRNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:MOLINARI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 CIVIC CENTER BLVD.
Mailing Address - Street 2:PCAM ROWAN BREAST CENTER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-615-5858
Mailing Address - Fax:856-769-7959
Practice Address - Street 1:3400 CIVIC CENTER BLVD.
Practice Address - Street 2:PCAM ROWAN BREAST CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-615-5858
Practice Address - Fax:856-769-7959
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2NR14615100363LA2200X
PASP014184363LA2200X
NJ26NJ00386700363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health