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General NPI Number Information
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NPI Number | 1245938489
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Entity Type | Individual
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Provider Name | TAYLOR NICOLE MOULD PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/17/2023
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 913 E 26TH ST STE 305
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City | MINNEAPOLIS
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State | MN
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Zip | 55404-4515
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Country | US
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Telephone | 612-871-7278
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Fax | 612-863-8531
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Provider Business Mailing Address
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Address Line | 2925 CHICAGO AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-1321
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Country | US
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Telephone | 612-262-9000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 14370
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 14370
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License Number State | MN
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