Provider Demographics
NPI:1972068070
Name:MISTY MOLINA, ARNP
Entity type:Organization
Organization Name:MISTY MOLINA, ARNP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, CNM, WHNP
Authorized Official - Phone:253-376-9070
Mailing Address - Street 1:PO BOX 734
Mailing Address - Street 2:
Mailing Address - City:FOX ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98333
Mailing Address - Country:US
Mailing Address - Phone:253-376-9070
Mailing Address - Fax:253-248-0149
Practice Address - Street 1:6002 WESTGATEBLVD., STE 120
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406
Practice Address - Country:US
Practice Address - Phone:253-376-9070
Practice Address - Fax:253-248-0149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2034218Medicaid