Provider Demographics
NPI:1255775532
Name:MOLANDER, JASON MICHAEL ALAN (LPN)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:MICHAEL ALAN
Last Name:MOLANDER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3216 W LIBERTY TREE LN
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-1755
Mailing Address - Country:US
Mailing Address - Phone:520-307-8157
Mailing Address - Fax:
Practice Address - Street 1:3216 W LIBERTY TREE LN
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-1755
Practice Address - Country:US
Practice Address - Phone:520-307-8157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP048721164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse