Provider Demographics
NPI:1588699227
Name:MOLINA, ISABEL B (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:ISABEL
Middle Name:B
Last Name:MOLINA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LINWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5360
Mailing Address - Country:US
Mailing Address - Phone:716-626-9016
Mailing Address - Fax:716-626-4271
Practice Address - Street 1:21 LINWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5360
Practice Address - Country:US
Practice Address - Phone:716-626-9016
Practice Address - Fax:716-626-4271
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY400750-1363L00000X
NY400750363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P89052Medicare UPIN
NYP89052Medicare UPIN
NYDD5580Medicare ID - Type Unspecified