Healthcare Provider Details

I. General information

NPI: 1144688227
Provider Name (Legal Business Name): LACONIA KOERNER L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 CLEVELAND AVE S
SAINT PAUL MN
55116-1345
US

IV. Provider business mailing address

3200 OAKLAND AVE APT 9
MINNEAPOLIS MN
55407-2043
US

V. Phone/Fax

Practice location:
  • Phone: 651-699-1207
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1744
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: