Healthcare Provider Details

I. General information

NPI: 1881307098
Provider Name (Legal Business Name): JENNIFER LOUISE OMAN L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5605 W 36TH ST STE 100C
ST LOUIS PARK MN
55416-2599
US

IV. Provider business mailing address

5605 W 36TH ST STE 100C
ST LOUIS PARK MN
55416-2599
US

V. Phone/Fax

Practice location:
  • Phone: 952-920-9247
  • Fax: 952-922-3480
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1961
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: