Individual
MRS. TIA MICHELLE GULLICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
105 INTERNATIONAL DR, STE. 126, RED LAKE FALLS, MN 56750-4665
(218) 253-4606
(218) 253-4681
Mailing address
105 INTERNATIONAL DR, STE. 126, RED LAKE FALLS, MN 56750-4665
(218) 253-4606
(218) 253-4681
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CNP 3937
MN
Other
Enumeration date
06/26/2015
Last updated
06/26/2015
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