Healthcare Provider Details

I. General information

NPI: 1972068070
Provider Name (Legal Business Name): MISTY MOLINA, ARNP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 WESTGATEBLVD., STE 120
TACOMA WA
98406
US

IV. Provider business mailing address

PO BOX 734
FOX ISLAND WA
98333
US

V. Phone/Fax

Practice location:
  • Phone: 253-376-9070
  • Fax: 253-248-0149
Mailing address:
  • Phone: 253-376-9070
  • Fax: 253-248-0149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MISTY M MOLINA
Title or Position: OWNER/PROVIDER
Credential: ARNP, CNM, WHNP
Phone: 253-376-9070