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General NPI Number Information
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NPI Number | 1881396901
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Entity Type | Individual
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Provider Name | NICOLE ELIZABETH MOL APRN
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Gender | Female
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Dates
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Enumeration Date | 03/21/2023
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Last Update Date | 05/04/2023
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Provider Practice Location Address
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Address Line | 1611 SILVERNAIL RD
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City | PEWAUKEE
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State | WI
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Zip | 53072-5519
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Country | US
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Telephone | 262-304-0150
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Fax |
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Provider Business Mailing Address
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Address Line | 2712 NORTHVIEW RD UNIT 116
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City | WAUKESHA
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State | WI
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Zip | 53188-2009
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Country | US
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Telephone | 201-575-3020
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 13890-33
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 255052-30
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License Number State | WI
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