Individual
CATHERINE MARY MANDLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
5200 FAIRVIEW BLVD, WYOMING, MN 55092-8013
(651) 982-7000
Mailing address
5200 FAIRVIEW BLVD, WYOMING, MN 55092-8013
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
14024
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14024
MINNESOTA STATE LICENSE NUMBER
MN
Enumeration date
02/06/2022
Last updated
08/09/2024
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