Individual
TAYLOR NICOLE MOULD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
913 E 26TH ST STE 305, MINNEAPOLIS, MN 55404-4515
(612) 871-7278
(612) 863-8531
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-9000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
14370
MN
363AS0400X
Surgical Physician Assistant
14370
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1200585
NCCPA
MN
Enumeration date
02/17/2023
Last updated
02/28/2025
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