Healthcare Provider Details

I. General information

NPI: 1528664612
Provider Name (Legal Business Name): EMILY VOLINKATY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY FAGERHOLM

II. Dates (important events)

Enumeration Date: 12/05/2020
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13688 ROGERS DR STE 230
ROGERS MN
55374-4918
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-977-0300
  • Fax: 952-977-0311
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7814
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: