Provider Demographics
NPI:1699164897
Name:MOLINA, LOUINA N (APRN, APNP-F)
Entity type:Individual
Prefix:
First Name:LOUINA
Middle Name:N
Last Name:MOLINA
Suffix:
Gender:F
Credentials:APRN, APNP-F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 W MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-7401
Mailing Address - Country:US
Mailing Address - Phone:815-338-6600
Mailing Address - Fax:
Practice Address - Street 1:4201 W MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-7401
Practice Address - Country:US
Practice Address - Phone:815-337-7100
Practice Address - Fax:815-337-4793
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012289363L00000X, 363LF0000X
IL209-012289363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1699164897OtherBCBSWI
WIMOLINLOUOtherMERCYCARE INSURANCE
IL209012289OtherSTATE LICENSE
WI1699164897Medicaid
WI1699164897OtherBCBSWI