Healthcare Provider Details

I. General information

NPI: 1174456545
Provider Name (Legal Business Name): AARON REICHARD RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10467 93RD AVE N
MAPLE GROVE MN
55369-4112
US

IV. Provider business mailing address

10467 93RD AVE N
MAPLE GROVE MN
55369-4112
US

V. Phone/Fax

Practice location:
  • Phone: 651-488-4655
  • Fax:
Mailing address:
  • Phone: 651-488-4655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR-2538060
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: