MEDICARE: MOLLANA CARSON PURDY AUD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	8346	MN

General Provider Information

NPI Number	:	1194989020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLANA CARSON PURDY AUD

Provider Business Mailing Address
First Line	:	8301 GOLDEN VALLEY RD STE 200
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55427-4475
Country	:	US
Telephone Number	:	763-233-5755
Fax Number	:	763-233-5782

Provider Business Practice Location Address
First Line	:	9825 HOSPITAL DR STE 203
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-4772
Country	:	US
Telephone Number	:	763-233-5755
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	08/15/2025

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