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General NPI Number Information
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NPI Number | 1265014641
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Entity Type | Individual
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Provider Name | PETRICA T MOLNAR
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Gender | Male
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Dates
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Enumeration Date | 04/25/2021
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Last Update Date | 05/17/2023
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Provider Practice Location Address
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Address Line | 102 N ADELAIDE ST STE C
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City | FENTON
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State | MI
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Zip | 48430-2670
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Country | US
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Telephone | 810-262-7030
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Fax | 810-208-0363
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Provider Business Mailing Address
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Address Line | 1 HURLEY PLZ ATTN PROFESSIONAL BILLING DEPT
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City | FLINT
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State | MI
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Zip | 48503-5902
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Country | US
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Telephone | 810-262-9002
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Fax | 810-262-9483
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704296874
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 4704296874
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 364SA2100X
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Taxonomy Name | Acute Care Clinical Nurse Specialist
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License Number | 4704296874
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number | 4704296874
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 4704296874
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License Number State | MI
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