Provider Demographics
NPI:1295191708
Name:TWILIGHT TATTOO
Entity type:Organization
Organization Name:TWILIGHT TATTOO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:LOUSIE
Authorized Official - Last Name:WALLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-214-1311
Mailing Address - Street 1:3054 BLOOMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1716
Mailing Address - Country:US
Mailing Address - Phone:612-722-2233
Mailing Address - Fax:
Practice Address - Street 1:3054 BLOOMINGTON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1716
Practice Address - Country:US
Practice Address - Phone:612-722-2233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, MedicalGroup - Single Specialty