Provider Demographics
NPI:1851048102
Name:MUSTAFA, MOLLY LYNN (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:LYNN
Last Name:MUSTAFA
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4648 CASSIDY RIDGE DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-8431
Mailing Address - Country:US
Mailing Address - Phone:507-291-9830
Mailing Address - Fax:507-291-9824
Practice Address - Street 1:4648 CASSIDY RIDGE DR NE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-8431
Practice Address - Country:US
Practice Address - Phone:507-291-9830
Practice Address - Fax:507-291-9824
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2457492163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant