Individual
MOLLY C BACKSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4621 E SUPERIOR ST, ESSENTIA HEALTH LAKESIDE CLINIC, DULUTH, MN 55804-2338
(218) 786-3550
Mailing address
4621 E SUPERIOR ST, ESSENTIA HEALTH LAKESIDE CLINIC, DULUTH, MN 55804-2338
(218) 786-3550
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R 181668-8
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730521717
—
MI
05
—
1730521717
—
WI
Enumeration date
07/19/2013
Last updated
10/15/2013
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