NPI 1003615030

Tibli Olandrus Dickson, MANAGER

Practitioner Nursing Home Administrator Champlin, MN

Practice location

Address: 7400 122nd Ave N, Champlin, MN 55316-2127
Phone: (612) 865-6220

Registered specialties

Nursing Home Administrator Primary

Nursing Service Related Providers Taxonomy 376G00000X

Other Nursing Home Administrator providers in Minnesota →

Registry record

NPI: 1003615030
Entity type: Individual
Sex (as registered): Male
NPI issued: 11 Mar 2025
Record last updated: 11 Mar 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.