MEDICARE: MRS. MOLLIE ANN GEIBEL RN, MSN, APRN, 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
1	363LF0000X	Family Nurse Practitioner	4704262514	MI

General Provider Information

NPI Number	:	1790597128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MOLLIE ANN GEIBEL RN, MSN, APRN, FNP-C

Provider Business Mailing Address
First Line	:	4040 LAKE GEORGE RD
Second Line	:
City	:	LEONARD
State	:	MI
Zip	:	48367-3701
Country	:	US
Telephone Number	:	248-765-5048
Fax Number	:

Provider Business Practice Location Address
First Line	:	43956 MOUND RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-2034
Country	:	US
Telephone Number	:	586-838-2464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2025
Last Update Date	:	01/22/2025

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