Provider Demographics
NPI:1801887377
Name:MINARD, MOLLY A (PA-C)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:A
Last Name:MINARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:110 BEECH ST STE B
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48763-8314
Mailing Address - Country:US
Mailing Address - Phone:989-362-9859
Mailing Address - Fax:989-362-9862
Practice Address - Street 1:110 BEECH ST
Practice Address - Street 2:STE B
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-8314
Practice Address - Country:US
Practice Address - Phone:989-362-1015
Practice Address - Fax:989-362-9862
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2021-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
MI5601004682207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery