Provider Demographics
NPI:1447721154
Name:DREWLO, MOLLY DWYER
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:DWYER
Last Name:DREWLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:DWYER
Other - Last Name:KLASSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4961 RICE LAKE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-8439
Mailing Address - Country:US
Mailing Address - Phone:218-727-4105
Mailing Address - Fax:218-740-3378
Practice Address - Street 1:4961 RICE LAKE RD STE 105
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55803-8439
Practice Address - Country:US
Practice Address - Phone:218-727-4105
Practice Address - Fax:218-740-3378
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2433060163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management