Healthcare Provider Details

I. General information

NPI: 1669567913
Provider Name (Legal Business Name): JENNIFER E WINER L.AC.,DIPL.AC., MSOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13911 RIDGEDALE DR STE 243
MINNETONKA MN
55305-1716
US

IV. Provider business mailing address

4205 GOLDENROD LN N
PLYMOUTH MN
55441-1242
US

V. Phone/Fax

Practice location:
  • Phone: 612-226-8840
  • Fax:
Mailing address:
  • Phone: 612-226-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number370-055
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1269
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: