Healthcare Provider Details

I. General information

NPI: 1245310754
Provider Name (Legal Business Name): COLLEEN PATRICE O'BRIEN L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 HIGHWAY 61 N STE 307
WHITE BEAR LAKE MN
55110-2753
US

IV. Provider business mailing address

446 BEAR AVE S
VADNAIS HEIGHTS MN
55127-7003
US

V. Phone/Fax

Practice location:
  • Phone: 612-741-3284
  • Fax:
Mailing address:
  • Phone: 651-330-9392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1459
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: