Timothy John Blackowikak, L.P.N

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

L36999-0 Issued in MN

Practice address

212 Forest Ave N
Dundas, MN 55019-3941

Phone

(612) 423-5639

NPI assigned

Apr 23, 2014

Last updated

Apr 23, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398211200000",
    "number": "1750701272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 FOREST AVE N",
            "city": "DUNDAS",
            "state": "MN",
            "postal_code": "550193941",
            "telephone_number": "612-423-5639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 FOREST AVE N",
            "city": "DUNDAS",
            "state": "MN",
            "postal_code": "550193941",
            "telephone_number": "612-423-5639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKOWIKAK",
        "first_name": "TIMOTHY",
        "middle_name": "JOHN",
        "credential": "L.P.N",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-23",
        "last_updated": "2014-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MN",
            "license": "L36999-0",
            "primary": true
        },
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "MN",
            "license": "L36999-0",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert D Aby, MD
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• Complete Chiropractic Inc
• Whitney Docken, M.S, CCC-SLP
• Epic Enterprises, Inc.
• Full Potential Therapy, LLC

• Licensed Practical Nurse in Dundas, MN
• Providers in Dundas, MN by specialty
• Licensed Practical Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.