Provider Demographics
NPI:1730724980
Name:AMUNDSON, MOLLY (PA-C)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:AMUNDSON
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2025 SLOAN PL STE 35
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2092
Mailing Address - Country:US
Mailing Address - Phone:651-772-1572
Mailing Address - Fax:651-772-1889
Practice Address - Street 1:2601 CENTENNIAL DR STE 100
Practice Address - Street 2:
Practice Address - City:NORTH ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-3087
Practice Address - Country:US
Practice Address - Phone:657-777-7414
Practice Address - Fax:651-748-5839
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2023-06-27
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Provider Licenses
StateLicense IDTaxonomies
MN13216363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant