Provider Demographics
NPI:1093191645
Name:VAISHNAV, MOLLY
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:
Last Name:VAISHNAV
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:CORNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:8 CRESCENT LN
Mailing Address - Street 2:
Mailing Address - City:NORTH OAKS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-6358
Mailing Address - Country:US
Mailing Address - Phone:218-760-6753
Mailing Address - Fax:
Practice Address - Street 1:8 CRESCENT LN
Practice Address - Street 2:
Practice Address - City:NORTH OAKS
Practice Address - State:MN
Practice Address - Zip Code:55127-6358
Practice Address - Country:US
Practice Address - Phone:218-760-6753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNF0715495363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily