Individual
TIMOTHY JOHN BLACKOWIKAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.P.N
Contact information
Practice address
212 FOREST AVE N, DUNDAS, MN 55019-3941
(612) 423-5639
Mailing address
212 FOREST AVE N, DUNDAS, MN 55019-3941
(612) 423-5639
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L36999-0
MN
164X00000X
Licensed Vocational Nurse
L36999-0
MN
Other
Enumeration date
04/23/2014
Last updated
04/23/2014
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