Provider Demographics
NPI:1679380992
Name:SKAUGE, MOLLY ELIZABETH (MN 2222747 ND R41180)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:ELIZABETH
Last Name:SKAUGE
Suffix:
Gender:F
Credentials:MN 2222747 ND R41180
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 ELM ST N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-2498
Mailing Address - Country:US
Mailing Address - Phone:701-239-3770
Mailing Address - Fax:
Practice Address - Street 1:2101 ELM ST N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2498
Practice Address - Country:US
Practice Address - Phone:701-239-3770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2222747163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health