Mackenburg Mohn, Mary D
Mackenburg Mohn, Mary D is an individual health care provider with primary practice located at 2450 Riverside Ave , Minneapolis MN 55454-1450. She recently has 5 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Acute Care, Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, Physician Assistants & Advanced Practice Nursing Providers / Primary Care, Physician Assistants & Advanced Practice Nursing Providers / Gerontology. Physician Assistants & Advanced Practice Nursing Providers / Gerontology is her primary health care specialty. Mackenburg Mohn, Mary D can be contacted via phone (126) 726-0006.Contact Information
Primary practice address
2450 Riverside Ave
Minneapolis MN 55454-1450
Phone: (126) 726-0006
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner | 363L00000X | R0933245 | Minnesota |
| Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner | 363L00000X | 0991736 | Colorado |
| Physician Assistants & Advanced Practice Nursing Providers / Acute Care | 363LA2100X | 0991736 | Colorado |
| Physician Assistants & Advanced Practice Nursing Providers / Pediatrics | 363LP0200X | R0933245 | Minnesota |
| Physician Assistants & Advanced Practice Nursing Providers / Primary Care | 363LP2300X | R0933245 | Minnesota |
| Physician Assistants & Advanced Practice Nursing Providers / Gerontology | 363LG0600X | 2472 | Minnesota |
Profile Details
| NPI number | 1073690012 |
|---|---|
| LBN Legal business name | Mackenburg Mohn, Mary D |
| Credentials | Nurse Practitioner (NP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 1st, 2006 |
| Last updated | Jun 14th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1073690012 | NPPES |
| Minnesota | MEDICAID | 878708200 |
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