Provider Demographics
NPI:1336238013
Name:MOLNAR, NICOLE L (PA-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:MOLNAR
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LEANN
Other - Last Name:EBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:775 S ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-5002
Mailing Address - Country:US
Mailing Address - Phone:717-782-5905
Mailing Address - Fax:717-782-5908
Practice Address - Street 1:775 S ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5002
Practice Address - Country:US
Practice Address - Phone:717-782-5905
Practice Address - Fax:717-782-5908
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052212363AM0700X, 363A00000X
PAOA004470363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103326430Medicaid
PA802109Medicare PIN