Provider Demographics
NPI:1487968665
Name:MOLINA, HEATHER A (PA-C)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:A
Last Name:MOLINA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:AMY
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1644 N 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-4133
Mailing Address - Country:US
Mailing Address - Phone:708-522-6792
Mailing Address - Fax:
Practice Address - Street 1:251 E HURON ST
Practice Address - Street 2:FEINBERG 4-710V
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2908
Practice Address - Country:US
Practice Address - Phone:312-926-5343
Practice Address - Fax:312-926-7382
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-003814363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant