Provider Demographics
NPI:1912632027
Name:MOLLNOW, DESIREE JOYCE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:JOYCE
Last Name:MOLLNOW
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:JOYCE
Other - Last Name:GIROUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:35 EMPIRE STATE BLVD
Practice Address - Street 2:
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033-9777
Practice Address - Country:US
Practice Address - Phone:518-477-2167
Practice Address - Fax:518-477-5182
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily