Provider Demographics
NPI:1881396901
Name:MOL, NICOLE ELIZABETH (APRN)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:MOL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:ELIZABETH
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2712 NORTHVIEW RD UNIT 116
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2009
Mailing Address - Country:US
Mailing Address - Phone:201-575-3020
Mailing Address - Fax:
Practice Address - Street 1:1611 SILVERNAIL RD
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-5519
Practice Address - Country:US
Practice Address - Phone:262-304-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI255052-30163W00000X
WI13890-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse