Provider Demographics
NPI:1881309334
Name:MALINA, MOLLY (NP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:MALINA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9365 COUNSELORS ROW STE 210
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-6418
Mailing Address - Country:US
Mailing Address - Phone:317-429-0101
Mailing Address - Fax:
Practice Address - Street 1:9365 COUNSELORS ROW STE 210
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-6418
Practice Address - Country:US
Practice Address - Phone:317-429-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28237771A163WE0003X
IN71013649A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency