=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336580596
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT JOHN GARRICK RN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2013
-----------------------------------------------------
Last Update Date | 01/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8987 92ND ST S
-----------------------------------------------------
City | COTTAGE GROVE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55016-4038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-263-4366
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4810 BRENT AVE
-----------------------------------------------------
City | INVER GROVE HEIGHTS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55076-1112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-263-4366
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WM0705X
-----------------------------------------------------
Taxonomy Name | Medical-Surgical Registered Nurse
-----------------------------------------------------
License Number | R 207677-3
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------