Provider Demographics
NPI:1053931162
Name:MULDER, HANNA DIANE (MD)
Entity type:Individual
Prefix:DR
First Name:HANNA
Middle Name:DIANE
Last Name:MULDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HANNA
Other - Middle Name:
Other - Last Name:ENGEBRETSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14050 NICOLLET AVE # 300 METROPOLITAN PEDIATRICS
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337
Mailing Address - Country:US
Mailing Address - Phone:952-435-2450
Mailing Address - Fax:
Practice Address - Street 1:14050 NICOLLET AVE # 300 METROPOLITAN PEDIATRICS
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337
Practice Address - Country:US
Practice Address - Phone:952-435-2450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-18
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN73756208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program