Healthcare Provider Details

I. General information

NPI: 1316710809
Provider Name (Legal Business Name): LYNDSEY ERIN MOLENKAMP FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 E PECOS RD STE 215
GILBERT AZ
85295-3202
US

IV. Provider business mailing address

1760 E PECOS RD STE 215
GILBERT AZ
85295-3202
US

V. Phone/Fax

Practice location:
  • Phone: 480-448-2411
  • Fax: 480-476-8718
Mailing address:
  • Phone: 480-448-2411
  • Fax: 480-476-8718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number299532
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: