Provider Demographics
NPI:1942459565
Name:LOVE, MOLLY J (PA-C)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:J
Last Name:LOVE
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:14000 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-5713
Mailing Address - Country:US
Mailing Address - Phone:952-993-8700
Mailing Address - Fax:952-993-8715
Practice Address - Street 1:14000 FAIRVIEW DR
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-5713
Practice Address - Country:US
Practice Address - Phone:952-993-8700
Practice Address - Fax:952-993-8715
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant