Healthcare Provider Details

I. General information

NPI: 1033466636
Provider Name (Legal Business Name): AMBER JAWASKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2937 LYNDALE AVE S SUITE 201
MINNEAPOLIS MN
55408-2177
US

IV. Provider business mailing address

2937 LYNDALE AVE S SUITE 201
MINNEAPOLIS MN
55408-2177
US

V. Phone/Fax

Practice location:
  • Phone: 612-879-8000
  • Fax: 612-879-8778
Mailing address:
  • Phone: 612-879-8000
  • Fax: 612-879-8778

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: