1245417153 NPI number — MRS. KRISTA LYNNE MOLLICK MACE ASSOCIATES

Table of content: MRS. KRISTA LYNNE MOLLICK MACE ASSOCIATES (NPI 1245417153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245417153 NPI number — MRS. KRISTA LYNNE MOLLICK MACE ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOLLICK MACE
Provider First Name:
KRISTA
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ASSOCIATES
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MACE
Provider Other First Name:
KRISTA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245417153
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
85 PLEASANT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HASTINGS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-480-4168
Provider Business Mailing Address Fax Number:
651-480-4339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 PLEASANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HASTINGS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-480-4168
Provider Business Practice Location Address Fax Number:
651-480-4339
Provider Enumeration Date:
01/23/2008

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: 225200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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