TIMOTHY JOHN BLACKOWIKAK (NPI# 1750701272) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750701272 |
| Entity Type | Individual |
| Full Name | TIMOTHY JOHN BLACKOWIKAK |
| Credential | L.P.N |
| Practice Address |
212 Forest Ave N Dundas MN 55019-3941 |
| Practice Telephone | 6124235639 |
| Mailing Telephone | 6124235639 |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2014-04-23 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 164W00000X | Licensed Practical Nurse | L36999-0 | MN | Nursing Service Providers |
| N | 164X00000X | Licensed Vocational Nurse | L36999-0 | MN | Nursing Service Providers |
| Street Address |
212 FOREST AVE N |
| City | DUNDAS |
| State | MN |
| Zip Code | 55019-3941 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174675359 | Epic Enterprises, Inc. | Day Training, Developmentally Disabled Services | 410 Stafford Lane, Dundas, MN 55019 | 2007-01-17 |
| 1821029828 | K Mart Corp | Pharmacy | South Highway 3, Dundas, MN 55019 | 2006-07-06 |
| 1033546767 | Bio-medical Applications of Minnesota, Inc. | Clinic/Center | 396 Schilling Dr S, Dundas, MN 55019-3948 | 2013-09-26 |
| 1053520213 | Jennifer Jean Pelletier | Music Therapist | 316 Archibald Ln, Dundas, MN 55019-3949 | 2007-05-22 |
| 1225355795 | Jon M Smestad | Pharmacist | 404 Schilling Dr N, Dundas, MN 55019-3968 | 2010-04-23 |
| 1982080032 | Michael James Heaton | Pharmacist | 404 Schilling Dr N, Dundas, MN 55019-3968 | 2015-07-30 |
| 1750718524 | Kmart Corporation | Pharmacy | 404 Schilling Dr N, Dundas, MN 55019-3968 | 2013-10-10 |
| 1548300932 | Grant Louis Modory | Chiropractor | 303 Hester St W, Dundas, MN 55019-3970 | 2007-02-07 |
| 1225218282 | Complete Chiropractic Inc | Chiropractor | 303 Hester St W, Dundas, MN 55019-3970 | 2007-11-07 |
| 1407397250 | Malcolm Watt | Specialist | 7 Cannon St W, Dundas, MN 55019-4039 | 2017-03-13 |
| Find all providers in zip 55019 | ||||
| Taxonomy Code | 164W00000X |
| Grouping | Nursing Service Providers |
| Classification | Licensed Practical Nurse |
| An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states. |
| Notes: Source: Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437774437 | Mackensie Eder | Licensed Practical Nurse | 12310 Singletree Ln Apt 2334, Eden Prairie, MN 55344-7983 | 2020-06-15 |
| 1659990331 | Sybilla Materla | Licensed Practical Nurse | 20694 Keystone Ave Unit C, Lakeville, MN 55044-6175 | 2020-04-13 |
| 1760021067 | S&e Staffing | Licensed Practical Nurse | 14250 43rd Ave N Apt D, Plymouth, MN 55446-3628 | 2020-01-03 |
| 1548815590 | Ritajo Ellenberger | Licensed Practical Nurse | 220 Oak Street North, Alexandria, MN 56308 | 2019-08-06 |
| 1699327858 | Agnes Remeshi | Licensed Practical Nurse | 2070 9th Ave E Apt 105, North Saint Paul, MN 55109-2242 | 2019-07-09 |
| 1780143453 | Shari Bernice Duwenhoegger | Licensed Practical Nurse | 9037 Garland Ln N, Maple Grove, MN 55311-1285 | 2019-03-13 |
| 1194281998 | Sawo M Lansana | Licensed Practical Nurse | 14125 Virginia Ave S Ste 311, Savage, MN 55378-2669 | 2019-02-16 |
| 1811453061 | Lacey Evelius | Licensed Practical Nurse | 400 Mineral Pond Ct, Anoka, MN 55303-1049 | 2019-02-13 |
| 1467923243 | Chinenye Amadi | Licensed Practical Nurse | 1350 High Site Dr Apt 218, Eagan, MN 55121-2153 | 2018-12-05 |
| 1992275606 | Maliki Fofee Kamara | Licensed Practical Nurse | 2451 109th Ave Nw Apt. 1, Coon Rapids, MN 55433 | 2018-11-26 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.