Individual
MOLLY SUE KMIECIAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
5981 MAIN ST NE UPPR APT, FRIDLEY, MN 55432-5442
(612) 707-4216
Mailing address
3401 E MEDICINE LAKE BLVD OFC 114, PLYMOUTH, MN 55441-2307
(763) 231-5939
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
774349
MN
Other
Enumeration date
01/31/2022
Last updated
01/31/2022
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