Healthcare Provider Details

I. General information

NPI: 1669741237
Provider Name (Legal Business Name): LIBBY K WEIBEL L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2011
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 NICOLLET AVE
MINNEAPOLIS MN
55409-2032
US

IV. Provider business mailing address

4325 NICOLLET AVE
MINNEAPOLIS MN
55409-2032
US

V. Phone/Fax

Practice location:
  • Phone: 651-440-6391
  • Fax:
Mailing address:
  • Phone: 651-440-6391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1553
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: