Healthcare Provider Details

I. General information

NPI: 1306703145
Provider Name (Legal Business Name): ROBIN KOWALSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6260 6TH ST NE
MINNEAPOLIS MN
55432-5037
US

IV. Provider business mailing address

6260 6TH ST NE
MINNEAPOLIS MN
55432-5037
US

V. Phone/Fax

Practice location:
  • Phone: 763-218-9950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberQ237111500612
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: