Healthcare Provider Details

I. General information

NPI: 1750644241
Provider Name (Legal Business Name): KIMBERLY A MOLINARI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD. PCAM ROWAN BREAST CENTER
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

3400 CIVIC CENTER BLVD. PCAM ROWAN BREAST CENTER
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 215-615-5858
  • Fax: 856-769-7959
Mailing address:
  • Phone: 215-615-5858
  • Fax: 856-769-7959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2NR14615100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP014184
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00386700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: