IndividualActive
Tibli Dickson, MANAGER
NPI 1003615030 · Nursing Home Administrator · Champlin, MN
Provider details
- NPI number
- 1003615030
- Entity type
- Individual
- Primary specialty
- Nursing Home AdministratorNursing Service Related Providers
- Credential
- MANAGER
- Sex
- Male
- Sole proprietor
- No
Specialties & taxonomies
Nursing Service Related Providers
Practice location
7400 122nd Ave N
Champlin, MN 55316-2127
Phone: (612) 865-6220
Approximate (ZIP-level) locationGet directions
Mailing address
7400 122nd Ave N
Champlin, MN 55316-2127
Registry dates
- Enumerated
- 2025-03-11
- Last updated
- 2025-03-11
- Certified
- 2025-03-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.