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NPI Code Detail

MEDICARE: MARK A MOLLNER FNP-C

MEDICARE: MARK A MOLLNER FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner24151992VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417949447
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK A MOLLNER FNP-C
Provider Business Mailing Address
First Line : 576 JEFFERSON AVE
Second Line : MCDONALD ARMY HEALTH CENTER- FAMILY HEALTH CLINIC
City : FORT EUSTIS
State : VA
Zip : 23604-1602
Country : US
Telephone Number : 757-314-7613
Fax Number :
Provider Business Practice Location Address
First Line : 5309 DISCOVERY PARK BLVD
Second Line :
City : WILLIAMSBURG
State : VA
Zip : 23188-2789
Country : US
Telephone Number : 757-914-6000
Fax Number : 757-914-6002
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2005
Last Update Date : 04/13/2026

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