Healthcare Provider Details

I. General information

NPI: 1093679045
Provider Name (Legal Business Name): EMILY GARDESKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 MERRYVIEW LN
HIBBING MN
55746-3444
US

IV. Provider business mailing address

1706 MERRYVIEW LN
HIBBING MN
55746-3444
US

V. Phone/Fax

Practice location:
  • Phone: 218-969-4793
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: