Provider Demographics
NPI:1912144619
Name:MOLINARI, MAUREEN PATRICIA (RD, CDE)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:PATRICIA
Last Name:MOLINARI
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10592
Mailing Address - Street 2:4234 MELODY RANCH DRIVE
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-0592
Mailing Address - Country:US
Mailing Address - Phone:307-203-2429
Mailing Address - Fax:
Practice Address - Street 1:4234 MELODY RANCH DRIVE
Practice Address - Street 2:POB 10592
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83002-0592
Practice Address - Country:US
Practice Address - Phone:307-203-2429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD548133V00000X
WY864610133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered