Healthcare Provider Details

I. General information

NPI: 1225786874
Provider Name (Legal Business Name): EMILY ROCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 APOLLO DR
LINO LAKES MN
55014-3004
US

IV. Provider business mailing address

576 APOLLO DR
LINO LAKES MN
55014-3004
US

V. Phone/Fax

Practice location:
  • Phone: 952-967-6620
  • Fax:
Mailing address:
  • Phone: 952-967-6620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number77861
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: