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Individual

MAILYN MARIE MOZINGO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PMHNP

Contact information

Practice address
510 4TH ST S, FARGO, ND 58103-1914
(701) 476-7200
Mailing address
219 LIONHEART DRIVE, HORACE, ND 58047
(701) 204-2804

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
R40973
ND
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R40973
ND

Other

Enumeration date
10/09/2023
Last updated
06/18/2024
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