| Doctor Name: | MICHAEL J MOLDENHAUER |
| NPI Number: | 1275837551 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP-C |
| License Number: | 2010040721 |
| Business Practice Address: | 624 Old Saint Marys Rd Suite A Perryville, MO - 637751837 |
| Business Phone Number: | 5735473232 |
| Business Fax Number: | 5735473231 |
| Mailing Address: | 624 Old Saint Marys Rd, Suite A PERRYVILLE |
| State: | MO |
| Postal Code: | 637751837 |
| Phone Number: | 5735473232 |
| Fax Number: | 5735473231 |
| NPI Enumeration Date: | 12/31/2010 |
| NPI Last Update Date: | 12/31/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 2010040721 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |