Healthcare Provider Details

I. General information

NPI: 1487545703
Provider Name (Legal Business Name): JENNIFER MOLINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2208 N WEBB RD UNIT 4
GRAND ISLAND NE
68803-1756
US

IV. Provider business mailing address

518 E CAPITAL AVE TRLR 14
GRAND ISLAND NE
68801-2472
US

V. Phone/Fax

Practice location:
  • Phone: 308-381-1690
  • Fax:
Mailing address:
  • Phone: 308-258-1763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number315P00000X
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number315P00000X
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: