Provider Demographics
NPI:1316236656
Name:MOLINARO, LISA NADYNE (PMHNP, RN, MFT, PHN)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:NADYNE
Last Name:MOLINARO
Suffix:
Gender:F
Credentials:PMHNP, RN, MFT, PHN
Other - Prefix:
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Mailing Address - Street 1:3569 ROUND BARN CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-5781
Mailing Address - Country:US
Mailing Address - Phone:707-579-8703
Mailing Address - Fax:707-579-8755
Practice Address - Street 1:3569 ROUND BARN CIR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-5781
Practice Address - Country:US
Practice Address - Phone:707-579-8703
Practice Address - Fax:707-579-8755
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP19554363LP0808X, 163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health