MEDICARE: MS. BRENDA GAIL GREWELL L AC

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	1204	MN

General Provider Information

NPI Number	:	1427130467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRENDA GAIL GREWELL L AC

Provider Business Mailing Address
First Line	:	2650 LOUISA AVE
Second Line	:
City	:	MOUNDS VIEW
State	:	MN
Zip	:	55112
Country	:	US
Telephone Number	:	612-850-1305
Fax Number	:	763-780-6207

Provider Business Practice Location Address
First Line	:	2650 LOUISA AVE
Second Line	:
City	:	MOUNDS VIEW
State	:	MN
Zip	:	55112
Country	:	US
Telephone Number	:	612-850-1305
Fax Number	:	763-780-6207

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	04/20/2011

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