Healthcare Provider Details

I. General information

NPI: 1467726877
Provider Name (Legal Business Name): VALERIE EASTERLUND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 REGENCY RD
LE SUEUR MN
56058-2136
US

IV. Provider business mailing address

216 REGENCY ROAD
LESUEUR MN
56058
US

V. Phone/Fax

Practice location:
  • Phone: 612-871-7878
  • Fax: 612-871-2567
Mailing address:
  • Phone: 612-871-7878
  • Fax: 612-871-2567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: