Provider Demographics
NPI:1114903622
Name:MCLAUGHLIN, MOLLY KATHERINE (RN, CPNP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:KATHERINE
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:KATHERINE
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5901 LINCOLN DRIVE
Mailing Address - Street 2:CBC-2-REV/PE
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-1611
Mailing Address - Country:US
Mailing Address - Phone:651-220-6608
Mailing Address - Fax:651-220-6064
Practice Address - Street 1:345 SMITH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2346
Practice Address - Country:US
Practice Address - Phone:651-220-6608
Practice Address - Fax:651-220-6064
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1448221363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics