Provider Demographics
NPI:1548541386
Name:VAN MOL, ALAINA CHRISTINE (N P)
Entity type:Individual
Prefix:
First Name:ALAINA
Middle Name:CHRISTINE
Last Name:VAN MOL
Suffix:
Gender:F
Credentials:N P
Other - Prefix:
Other - First Name:ALAINA
Other - Middle Name:CHICOLA
Other - Last Name:VAN MOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N P
Mailing Address - Street 1:3916 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3007
Mailing Address - Country:US
Mailing Address - Phone:318-445-2223
Mailing Address - Fax:318-445-2573
Practice Address - Street 1:3916 JACKSON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3007
Practice Address - Country:US
Practice Address - Phone:318-445-2223
Practice Address - Fax:318-445-2573
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06623363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2166816Medicaid
LA2166816Medicaid