Healthcare Provider Details

I. General information

NPI: 1013153915
Provider Name (Legal Business Name): MRS. CHERYL J FICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2008
Last Update Date: 12/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5695 BLAINE AVE
INVER GROVE HEIGHTS MN
55076-1226
US

IV. Provider business mailing address

14235 DAVENPORT CT
ROSEMOUNT MN
55068-4174
US

V. Phone/Fax

Practice location:
  • Phone: 651-554-9940
  • Fax: 651-554-9941
Mailing address:
  • Phone: 651-423-3569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number103324
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: