Healthcare Provider Details

I. General information

NPI: 1659257756
Provider Name (Legal Business Name): SKYLAR B KOTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 5TH ST N APT 211
HOPKINS MN
55305-6202
US

IV. Provider business mailing address

1502 5TH ST N APT 211
HOPKINS MN
55305-6202
US

V. Phone/Fax

Practice location:
  • Phone: 952-456-1337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number5361442
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: