Provider Demographics
NPI:1619526142
Name:CASEY, MOLLY (DNP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:CASEY
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12890 N BAY TRL
Mailing Address - Street 2:
Mailing Address - City:SIDE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55781-7409
Mailing Address - Country:US
Mailing Address - Phone:218-969-9629
Mailing Address - Fax:
Practice Address - Street 1:750 E 34TH ST
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2341
Practice Address - Country:US
Practice Address - Phone:218-262-4881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-07
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2465687163WM0705X
MN10618363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2465687OtherSTATE OF MINNESOTA