Healthcare Provider Details

I. General information

NPI: 1164891099
Provider Name (Legal Business Name): MOLLY FRANKLIN JANIK WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5851 W 95TH ST SUITE 300
OAK LAWN IL
60453-2362
US

IV. Provider business mailing address

10408 AILEEN AVE
MOKENA IL
60448-1785
US

V. Phone/Fax

Practice location:
  • Phone: 708-499-9800
  • Fax: 708-499-6203
Mailing address:
  • Phone: 708-653-2565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209.013342
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: