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General NPI Number Information
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NPI Number | 1457228843
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Entity Type | Organization
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Legal Business Name | MINN SKIN LLC
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Dates
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Enumeration Date | 10/20/2025
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 5615 150TH ST N PO 363
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City | HUGO
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State | MN
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Zip | 55038-3535
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Country | US
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Telephone | 651-243-0369
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Fax | 651-331-5343
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Provider Business Mailing Address
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Address Line | 5615 150TH ST N PO 363
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City | HUGO
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State | MN
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Zip | 55038-3535
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Country | US
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Telephone | 651-243-0369
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Fax | 651-331-5343
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | ALICIA SKUPA
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Credential | PA-C
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Telephone | 651-243-0369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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