Basic Information
| Provider Information | |||||||||
| NPI: | 1417939935 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOLENAAR | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | SUSAN | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1013 STOWBRIDGE LN | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405155073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592710245 | ||||||||
| FaxNumber: | 8593231119 | ||||||||
| Practice Location | |||||||||
| Address1: | U.K. UNIVERSITY HEALTH SERVICE 740 S. LIMESTONE ST | ||||||||
| Address2: | KY CLINIC SUITE 163-B | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593235511 | ||||||||
| FaxNumber: | 8593231119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 10/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0807X | 3002423 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Child & Adolescent | 363LP0808X | KY 2423S | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.