Healthcare Provider Details

I. General information

NPI: 1255954475
Provider Name (Legal Business Name): KAREN ELORDUY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4590 SCOTT TRL STE 110
EAGAN MN
55122-5250
US

IV. Provider business mailing address

4590 SCOTT TRL STE 110
EAGAN MN
55122-5250
US

V. Phone/Fax

Practice location:
  • Phone: 651-454-1000
  • Fax: 651-454-4375
Mailing address:
  • Phone: 651-454-1000
  • Fax: 651-454-4375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: