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DR. MARY D MACKENBURG MOHN NP

>> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1073690012

Individual Registrant:
DR. MARY D MACKENBURG MOHN NP
Gender: F
Not Sole Proprietor

Location and contact information for practice:
500 MAIN AVE  BAUDETTE, MN 56623 US
Tel: 218-634-3400  Fax: --

Contact information for business:
2910 CENTRE POINTE DRIVE 35121A CHILDRENS HEALTH CARE ROSEVILLE, MN 55113 US
Tel: 651-855-2327  Fax: 651-855-2310

Registration Information:
NPI: 1073690012
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N363L00000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
MNR0933245
N363L00000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
CO0991736
N363LP0200XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
MNR0933245
N363LP2300XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
MNR0933245
Y363LA2100XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
CO0991736

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
878708200MN05




HEALTH CARE JOBS MN - Page 1



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