Healthcare Provider Details

I. General information

NPI: 1124328372
Provider Name (Legal Business Name): DIANE TANNING L.AC., MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10505 WAYZATA BLVD SUITE 200
MINNETONKA MN
55305-1502
US

IV. Provider business mailing address

10505 WAYZATA BLVD., SUITE 200
MINNETONKA MN
55305-1506
US

V. Phone/Fax

Practice location:
  • Phone: 763-546-5797
  • Fax: 763-546-5754
Mailing address:
  • Phone: 763-546-5797
  • Fax: 763-546-5754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1323
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: