Healthcare Provider Details

I. General information

NPI: 1194794107
Provider Name (Legal Business Name): VIRGINIA JEAN MOL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 S MEDICAL DR STE 200
BRIGHAM CITY UT
84302-3293
US

IV. Provider business mailing address

1041 S MEDICAL DR STE 200
BRIGHAM CITY UT
84302-3293
US

V. Phone/Fax

Practice location:
  • Phone: 435-723-5248
  • Fax: 435-723-5240
Mailing address:
  • Phone: 435-723-5248
  • Fax: 435-723-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number98-362692-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: