Provider Demographics
NPI:1154829661
Name:MOLZAHN, THERESE CHRISTINE (RD)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:CHRISTINE
Last Name:MOLZAHN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:THERESE
Other - Middle Name:
Other - Last Name:BREDEMUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:4616 33RD AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-3829
Mailing Address - Country:US
Mailing Address - Phone:952-393-4253
Mailing Address - Fax:
Practice Address - Street 1:4616 33RD AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-3829
Practice Address - Country:US
Practice Address - Phone:952-393-4253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT89449133V00000X
MN3881133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered