Provider Demographics
NPI:1932559564
Name:SOEBY, MOLLY JEAN (MT, SC (ASCP), MPA)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:JEAN
Last Name:SOEBY
Suffix:
Gender:F
Credentials:MT, SC (ASCP), MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 OAK ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4460
Mailing Address - Country:US
Mailing Address - Phone:218-230-0070
Mailing Address - Fax:800-958-7702
Practice Address - Street 1:151 S 4TH ST
Practice Address - Street 2:STE 302
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4715
Practice Address - Country:US
Practice Address - Phone:701-780-8229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND90-0456-I246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist