Healthcare Provider Details

I. General information

NPI: 1669735486
Provider Name (Legal Business Name): DONALD JOSHUA ARICKX PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 3RD AVE
ALBANY MN
56307-9363
US

IV. Provider business mailing address

320 3RD AVE
ALBANY MN
56307-9363
US

V. Phone/Fax

Practice location:
  • Phone: 320-845-2157
  • Fax: 320-845-6138
Mailing address:
  • Phone: 320-845-2157
  • Fax: 320-845-6138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1734
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: