Healthcare Provider Details

I. General information

NPI: 1386958569
Provider Name (Legal Business Name): STEFANIE L EMMINGS MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 HAMEL RD
HAMEL MN
55340-4567
US

IV. Provider business mailing address

75 HAMEL RD P O BOX 271
HAMEL MN
55340-4567
US

V. Phone/Fax

Practice location:
  • Phone: 763-478-3978
  • Fax: 763-478-3502
Mailing address:
  • Phone: 763-478-3978
  • Fax: 763-478-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: