MEDICARE: NICOLE LONERGAN LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	2120	MN

General Provider Information

NPI Number	:	1215889027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE LONERGAN LAC

Provider Business Mailing Address
First Line	:	4841 WASHBURN AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55410-1851
Country	:	US
Telephone Number	:	952-797-3097
Fax Number	:

Provider Business Practice Location Address
First Line	:	1624 HARMON PL STE 205
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-9817
Country	:	US
Telephone Number	:	612-389-8750
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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Directions to “ NICOLE LONERGAN LAC” Practice Location

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