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General NPI Number Information
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NPI Number | 1538792874
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Entity Type | Individual
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Provider Name | MS. MOLLY ANN ANDERSON
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Gender | Female
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Dates
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Enumeration Date | 02/14/2020
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 407 E 3RD ST
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City | DULUTH
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State | MN
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Zip | 55805-1950
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Country | US
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Telephone | 218-340-5781
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Fax |
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Provider Business Mailing Address
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Address Line | SSB-6 400 E 3RD ST
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City | DULUTH
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State | MN
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Zip | 55805
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Country | US
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Telephone | 218-786-8364
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 13514
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License Number State | MN
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