Provider Demographics
NPI:1942516802
Name:LINCOLN, TEILO (HOME MAKER)
Entity Type:Individual
Prefix:
First Name:TEILO
Middle Name:
Last Name:LINCOLN
Suffix:
Gender:M
Credentials:HOME MAKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5775 WAYZATA BLVD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1222
Mailing Address - Country:US
Mailing Address - Phone:763-732-9685
Mailing Address - Fax:
Practice Address - Street 1:1595 68TH AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55432-4714
Practice Address - Country:US
Practice Address - Phone:763-732-9685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-28
Last Update Date:2010-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN348032OtherCLASS A PROFESSIONAL HOME HEALTH AGENCY