Thalacker, Mark K

Thalacker, Mark K is an individual health care provider with primary practice located at 1875 Woodwinds Dr Suite 130, Woodbury MN 55125-2298. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as his primary health care specialty. Thalacker, Mark K can be contacted via phone (651) 232-0500.

Contact Information

Primary practice address
1875 Woodwinds Dr Suite 130 Woodbury MN 55125-2298
Phone: (651) 232-0500
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X R096321-5 Minnesota

Profile Details

NPI number 1063483493
LBN Legal business name Thalacker, Mark K
Credentials Certified Nurse Practitioner (CNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 1st, 2006
Last updated Feb 26th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063483493 NPPES
Minnesota MEDICAID 815725100

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