Individual
DR. MARY D MACKENBURG MOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2450 RIVERSIDE AVE, MINNEAPOLIS, MN 55454-1450
(126) 726-0006
Mailing address
2910 CENTRE POINTE DRIVE, 35121A CHILDRENS HEALTH CARE, ROSEVILLE, MN 55113
(651) 855-2327
(651) 855-2310
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0991736
CO
363L00000X
Nurse Practitioner
R0933245
MN
363LA2100X
Acute Care Nurse Practitioner
0991736
CO
363LG0600X
Gerontology Nurse Practitioner
Primary
2472
MN
363LP0200X
Pediatric Nurse Practitioner
R0933245
MN
363LP2300X
Primary Care Nurse Practitioner
R0933245
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
878708200
—
MN
Enumeration date
11/01/2006
Last updated
06/14/2022
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