Healthcare Provider Details

I. General information

NPI: 1124572110
Provider Name (Legal Business Name): DAWN PIVEC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 SELBY AVE
SAINT PAUL MN
55104-6304
US

IV. Provider business mailing address

1523 SELBY AVE
SAINT PAUL MN
55104-6304
US

V. Phone/Fax

Practice location:
  • Phone: 651-270-6140
  • Fax:
Mailing address:
  • Phone: 651-270-6140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1787
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: