MEDICARE: STEPHANIE DUSENBERRY LMT

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	174400000X	Specialist

General Provider Information

NPI Number	:	1437328861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE DUSENBERRY LMT

Provider Business Mailing Address
First Line	:	1002 CLEVELAND AVE S
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-1866
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 CLEVELAND AVE S
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-1866
Country	:	US
Telephone Number	:	763-218-5511
Fax Number	:

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

Provider Enumeration Date	:	02/29/2008
Last Update Date	:	02/29/2008

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