Individual
ERIC MJELDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
705 PLEASANT AVE S, PARK RAPIDS, MN 56470-1440
(218) 732-2800
(218) 732-2857
Mailing address
1027 WASHINGTON AVE, DETROIT LAKES, MN 56501-3409
(218) 732-2800
(218) 732-2857
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11663
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588064299
—
MN
Enumeration date
08/29/2014
Last updated
12/26/2015
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