Healthcare Provider Details

I. General information

NPI: 1639783079
Provider Name (Legal Business Name): JESSE C MOLINE ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 MERIDIAN ST
BELLINGHAM WA
98225-1732
US

IV. Provider business mailing address

3600 MERIDIAN ST
BELLINGHAM WA
98225-1732
US

V. Phone/Fax

Practice location:
  • Phone: 360-676-6000
  • Fax:
Mailing address:
  • Phone: 360-676-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61428603
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61428603
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberWA60932064
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: