Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Molly Jane Tiesenga, APRN

Individual provider Gerontology Nurse Practitioner · NPI 1063977932

Molly Jane Tiesenga, APRN is a Nurse Practitioner in Grand Rapids, Michigan. Qualified in 2018, 8 years ago. Practices with Legacy Clinics LLC, a 718-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Michigan and Oregon.

Years since qualifying
8
Licensed in
MI, OR
In the registry since
2019
Specialties on file
2
What do these letters mean?
APRN — Advanced Practice Registered Nurse
The umbrella licence covering nurse practitioners, midwives, anaesthetists and clinical nurse specialists.

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Practice location Address checks out

426 Michigan St NE
Grand Rapids, MI 49503-5609
Phone: (616) 267-8338
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Adult Health Nurse Practitioner (primary) Taxonomy 363LA2200X · Licence 10021431 (OR)
Gerontology Nurse Practitioner Taxonomy 363LG0600X · Licence 4704313324 (MI)

Record details

NPI number1063977932
Entity typeIndividual (Type 1)
GenderFemale
Credentials APRN
Sole proprietorNo
NPI enumeratedFebruary 5, 2019
Last updated in NPPESApril 3, 2024
Certification dateApril 3, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Legacy Clinics Llc — 718 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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