Healthcare Provider Details

I. General information

NPI: 1427367176
Provider Name (Legal Business Name): MRS. NICOLE DENISE MOLLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 ANAMARIA DR STE 133
RAPID CITY SD
57701-7376
US

IV. Provider business mailing address

PO BOX 317
BLACK HAWK SD
57718-0317
US

V. Phone/Fax

Practice location:
  • Phone: 605-721-4800
  • Fax: 605-721-4836
Mailing address:
  • Phone: 605-721-4800
  • Fax: 605-721-4836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: