Healthcare Provider Details

I. General information

NPI: 1467370502
Provider Name (Legal Business Name): JOANNA DEMKIEWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 2ND ST NE
MINNEAPOLIS MN
55413-1130
US

IV. Provider business mailing address

2701 MERIDIAN DR
ROBBINSDALE MN
55422-3744
US

V. Phone/Fax

Practice location:
  • Phone: 612-345-5648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: