Provider Demographics
NPI:1588921803
Name:DESAI, MOLLEEN KOFMAN (CRNP)
Entity type:Individual
Prefix:
First Name:MOLLEEN
Middle Name:KOFMAN
Last Name:DESAI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-2026
Mailing Address - Country:US
Mailing Address - Phone:205-401-8683
Mailing Address - Fax:
Practice Address - Street 1:2200 MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-2026
Practice Address - Country:US
Practice Address - Phone:205-401-8683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-061433363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily