Provider Demographics
NPI:1053136937
Name:MOLINA DE PENA, JANETHE (APRN,FNP-C)
Entity type:Individual
Prefix:
First Name:JANETHE
Middle Name:
Last Name:MOLINA DE PENA
Suffix:
Gender:F
Credentials:APRN,FNP-C
Other - Prefix:
Other - First Name:LESBIA
Other - Middle Name:JANETHE
Other - Last Name:MOLINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5915 KIT COVE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-2088
Mailing Address - Country:US
Mailing Address - Phone:702-561-0590
Mailing Address - Fax:
Practice Address - Street 1:5915 KIT COVE COURT
Practice Address - Street 2:
Practice Address - City:LV
Practice Address - State:NV
Practice Address - Zip Code:89131
Practice Address - Country:US
Practice Address - Phone:702-561-0590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM71797363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily