Healthcare Provider Details

I. General information

NPI: 1366319816
Provider Name (Legal Business Name): MYAKKA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 SUMMIT AVE
SAINT PAUL MN
55102-2117
US

IV. Provider business mailing address

1394 JACKSON ST
SAINT PAUL MN
55117-4629
US

V. Phone/Fax

Practice location:
  • Phone: 612-767-0309
  • Fax:
Mailing address:
  • Phone: 651-478-7828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name: THERESA MARIE BOWLIN
Title or Position: PRESIDENT
Credential:
Phone: 651-478-7828