Healthcare Provider Details

I. General information

NPI: 1881309334
Provider Name (Legal Business Name): MOLLY MALINA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 KEYSTONE XING STE 540
INDIANAPOLIS IN
46240-2130
US

IV. Provider business mailing address

8900 KEYSTONE XING STE 540
INDIANAPOLIS IN
46240-2130
US

V. Phone/Fax

Practice location:
  • Phone: 317-429-0120
  • Fax:
Mailing address:
  • Phone: 317-429-0120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71013649A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number28237771A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: