Individual
MS. ERICA LEE MAHLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
15290 PENNOCK LN, APPLE VALLEY, MN 55124-7163
(952) 853-8800
Mailing address
8170 33RD AVE S # MS 21110Q, MINNEAPOLIS, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12382
MN
Other
Enumeration date
03/21/2017
Last updated
06/04/2020
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