Provider Demographics
NPI:1821471863
Name:SEYDEL, MOLLI (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MOLLI
Middle Name:
Last Name:SEYDEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MOLLI
Other - Middle Name:
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7841 AMANA TRL
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55077-2609
Mailing Address - Country:US
Mailing Address - Phone:651-234-2950
Mailing Address - Fax:
Practice Address - Street 1:7841 AMANA TRL
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55077-2609
Practice Address - Country:US
Practice Address - Phone:651-234-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11902363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN11902OtherMN DEPT OF MEDICINE LICENSE