Individual
TIMOTHY JOHN STEPHENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
22251 169TH ST NW, BIG LAKE, MN 55309-8220
(612) 710-8451
Mailing address
22251 169TH ST NW, BIG LAKE, MN 55309-8220
(612) 710-8451
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
BC767187
MN
Other
Enumeration date
11/13/2021
Last updated
11/13/2021
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