Healthcare Provider Details

I. General information

NPI: 1184588931
Provider Name (Legal Business Name): NICHOLAS PERRY DE GROOT RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

609 3RD ST
FARMINGTON MN
55024-1508
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-4411
  • Fax:
Mailing address:
  • Phone: 651-200-7199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279E1000X
TaxonomyEducational Registered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: