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General NPI Number Information
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NPI Number | 1104241280
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Entity Type | Organization
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Legal Business Name | BIRCH HAVEN COMMUNITY ACUPUNCTURE
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Dates
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Enumeration Date | 02/25/2014
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Last Update Date | 02/25/2014
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Provider Practice Location Address
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Address Line | 14041 BURNHAVEN DR SUITE 120
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City | BURNSVILLE
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State | MN
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Zip | 55337-4921
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Country | US
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Telephone | 952-898-1808
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Fax |
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Provider Business Mailing Address
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Address Line | 14041 BURNHAVEN DR SUITE 120
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City | BURNSVILLE
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State | MN
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Zip | 55337-4921
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Country | US
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Telephone | 952-898-1808
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | NADA LYN ROBERTSON HOGAN
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Credential | L.AC
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Telephone | 952-898-1808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 1654
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License Number State | MN
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