1255326872 NPI number — CORINNE NADINE MOLL MD

Table of content: CORINNE NADINE MOLL MD (NPI 1255326872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255326872 NPI number — CORINNE NADINE MOLL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOLL
Provider First Name:
CORINNE
Provider Middle Name:
NADINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255326872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 NICOLLET MALL
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-333-2503
Provider Business Mailing Address Fax Number:
612-333-7080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 NICOLLET MALL SUITE 400
Provider Second Line Business Practice Location Address:
JOHN A HAUGEN ASSOCIATES PA
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-333-2503
Provider Business Practice Location Address Fax Number:
612-333-7080
Provider Enumeration Date:
09/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  45264 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2432783 . This is a "AMERICA'S PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 265P9MO . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP60855 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 34834900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: FP9041046550 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0704755 . This is a "MEDICA CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0700065 . This is a "MEDICA DUAL/MEDICARE MA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 182801 . This is a "U-CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 185156000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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