Basic Information
| Provider Information | |||||||||
| NPI: | 1255326872 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOLL | ||||||||
| FirstName: | CORINNE | ||||||||
| MiddleName: | NADINE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 NICOLLET MALL | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123332503 | ||||||||
| FaxNumber: | 6123337080 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 NICOLLET MALL SUITE 400 | ||||||||
| Address2: | JOHN A HAUGEN ASSOCIATES PA | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123332503 | ||||||||
| FaxNumber: | 6123337080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207V00000X | 45264 | MN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 2432783 | 01 | MN | AMERICA'S PPO | OTHER | 265P9MO | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER | HP60855 | 01 | MN | HEALTH PARTNERS | OTHER | 34834900 | 05 | WI | MEDICAID | FP9041046550 | 01 | MN | PREFERRED ONE | OTHER | 0704755 | 01 | MN | MEDICA CHOICE | OTHER | 0700065 | 01 | MN | MEDICA DUAL/MEDICARE MA | OTHER | 182801 | 01 | MN | U-CARE | OTHER | 185156000 | 05 | MN | MEDICAID |