Provider Demographics
NPI:1891125159
Name:MOL, HEATHER JILL (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JILL
Last Name:MOL
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:JILL
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 44TH ST SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 JEFFERSON AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4502
Practice Address - Country:US
Practice Address - Phone:616-685-6225
Practice Address - Fax:616-222-3766
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704227672363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health