Healthcare Provider Details

I. General information

NPI: 1609845833
Provider Name (Legal Business Name): ALICIA J WOJCHIK N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICIA J MIKKONEN N.P.

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110105 PIONEER TRL W SUITE 302
CHASKA MN
55318-2680
US

IV. Provider business mailing address

110105 PIONEER TRL W SUITE 302
CHASKA MN
55318-2680
US

V. Phone/Fax

Practice location:
  • Phone: 952-361-5800
  • Fax: 952-361-5858
Mailing address:
  • Phone: 952-361-5800
  • Fax: 952-361-5858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR143499-2
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR143499-2
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: