Healthcare Provider Details

I. General information

NPI: 1730659475
Provider Name (Legal Business Name): NEDDA KAY GREER LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NEDDA KAY JASTREMSKY LAC

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRACARE CLINIC 2001 STOCKINGER DR, STE 101
ST CLOUD MN
56303-1243
US

IV. Provider business mailing address

CENTRACARE CLINIC 2001 STOCKINGER DR, STE 101
ST CLOUD MN
56303-1243
US

V. Phone/Fax

Practice location:
  • Phone: 320-534-3096
  • Fax:
Mailing address:
  • Phone: 320-534-3096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1869
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: