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General NPI Number Information
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NPI Number | 1376408567
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Entity Type | Individual
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Provider Name | MS. GRACE VANDER MOLEN
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Gender | Female
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Dates
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Enumeration Date | 12/19/2025
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 1425 PORTLAND AVE
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City | ROCHESTER
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State | NY
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Zip | 14621-3011
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Country | US
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Telephone | 315-877-8764
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Fax |
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Provider Business Mailing Address
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Address Line | 224 WELLINGTON RD
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City | SYRACUSE
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State | NY
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Zip | 13214-2226
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Country | US
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Telephone | 315-877-8764
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Fax |
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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 | 163WX0003X
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Taxonomy Name | Inpatient Obstetric Registered Nurse
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License Number | 867833
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License Number State | NY
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