Healthcare Provider Details

I. General information

NPI: 1881585917
Provider Name (Legal Business Name): TITAN WOUND CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7559 ODAY LN NE
OTSEGO MN
55330-6314
US

IV. Provider business mailing address

7559 ODAY LN NE
OTSEGO MN
55330-6314
US

V. Phone/Fax

Practice location:
  • Phone: 612-214-0386
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREW NICHOLSON
Title or Position: OWNER
Credential: MD
Phone: 612-214-0385