Provider Demographics
NPI:1972974368
Name:MOLINARO, CHRISTINA (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:MOLINARO
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 HOSPITAL DR STE 212
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53098-3336
Mailing Address - Country:US
Mailing Address - Phone:920-471-4044
Mailing Address - Fax:
Practice Address - Street 1:123 HOSPITAL DR STE 212
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53098-3336
Practice Address - Country:US
Practice Address - Phone:920-471-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3679 - 23363A00000X
WI3679-23363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1972974368Medicaid