Individual
MOLLY AUGUSTINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5803 NEAL AVE N, OAK PARK HEIGHTS, MN 55082-2177
(651) 351-2653
Mailing address
1280 LARPENTEUR AVE W, APT. 323, SAINT PAUL, MN 55113-6340
(651) 285-2449
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2193
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2193
STATE OF MINNESOTA BOARD OF MEDICAL PRACTICE
MN
Enumeration date
06/05/2014
Last updated
06/05/2014
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