Provider Demographics
NPI:1104520410
Name:MOLINA, EVELYN VIANEY (APRN)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:VIANEY
Last Name:MOLINA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2979 DEER VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6626
Mailing Address - Country:US
Mailing Address - Phone:678-650-6810
Mailing Address - Fax:
Practice Address - Street 1:2979 DEER VALLEY CT
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6626
Practice Address - Country:US
Practice Address - Phone:678-650-6810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN296768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily