Healthcare Provider Details

I. General information

NPI: 1972290286
Provider Name (Legal Business Name): NEW LEAF ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21830 OLINDA LN N
SCANDIA MN
55073-9702
US

IV. Provider business mailing address

21830 OLINDA LN N
SCANDIA MN
55073-9702
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 Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAWN M PIVEC
Title or Position: ACUPUNCTURIST
Credential:
Phone: 651-270-6140