Provider Demographics
NPI:1710565080
Name:MLODZIK, GABRIEL PAUL (CNP)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:PAUL
Last Name:MLODZIK
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 WINNETKA AVE N APT 515
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-3688
Mailing Address - Country:US
Mailing Address - Phone:701-741-3482
Mailing Address - Fax:
Practice Address - Street 1:3655 PLYMOUTH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-3665
Practice Address - Country:US
Practice Address - Phone:763-316-0199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily