Healthcare Provider Details

I. General information

NPI: 1932400215
Provider Name (Legal Business Name): LYNN MULSO RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 W CENTER ST STE 208
ROCHESTER MN
55902-6278
US

IV. Provider business mailing address

122 WILSON ST
ALDEN MN
56009-1016
US

V. Phone/Fax

Practice location:
  • Phone: 507-529-0436
  • Fax: 507-529-0435
Mailing address:
  • Phone: 507-529-0436
  • Fax: 507-529-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH6254
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: