Molly Sue Kmieciak, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

774349 Issued in MN

Practice address

5981 Main St NE Uppr Apt
Fridley, MN 55432-5442

Phone

(612) 707-4216

NPI assigned

Jan 31, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643587200000",
    "number": "1750034633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 E MEDICINE LAKE BLVD OFC 114",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554412307",
            "telephone_number": "763-231-5939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5981 MAIN ST NE UPPR APT",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554325442",
            "telephone_number": "612-707-4216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KMIECIAK",
        "first_name": "MOLLY",
        "middle_name": "SUE",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-31",
        "last_updated": "2022-01-31",
        "certification_date": "2022-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MN",
            "license": "774349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Min Kim, PHARMD
• David Mark King, M.D.
• Lisa Kingsbury, MA, LPCC
• Annie Kline, OTR/L
• James Edwin Klussman
• Kelsey Elise Knutson
• Jagdeep Kohli, MD
• Anita C Konikoff, CCC-A
• Adelyn Ruth Kopp, OTR/L
• Jennifer Jean Kouri, RN

• Licensed Practical Nurse in Fridley, MN
• Providers in Fridley, MN by specialty
• Licensed Practical Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.