Basic Information
| Provider Information | |||||||||
| NPI: | 1033481403 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOLLET | ||||||||
| FirstName: | BRITTANY | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1508 W 22ND ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053283840 | ||||||||
| FaxNumber: | 6053283841 | ||||||||
| Practice Location | |||||||||
| Address1: | 1508 W 22ND ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053283840 | ||||||||
| FaxNumber: | 6053283841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2012 | ||||||||
| LastUpdateDate: | 06/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0807 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.