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General NPI Number Information
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NPI Number | 1609158567
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ACUPUNCTURE AND WELLNESS CENTER
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Dates
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Enumeration Date | 09/15/2011
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Last Update Date | 09/15/2011
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Provider Practice Location Address
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Address Line | 2388 UNIVERSITY AVE W STE 206
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City | SAINT PAUL
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State | MN
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Zip | 55114-1769
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Country | US
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Telephone | 651-644-4460
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Fax | 651-787-0957
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Provider Business Mailing Address
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Address Line | 2388 UNIVERSITY AVE W STE 206
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City | SAINT PAUL
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State | MN
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Zip | 55114-1769
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Country | US
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Telephone | 651-644-4460
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Fax | 651-787-0957
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Authorized Official
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Title or Position | LICENSED ACUPUNCTURIST
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Name | MS. NANCY ELLEN ANDERSON-BIERMA
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Credential | L.AC
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Telephone | 651-644-4460
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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 | 1126
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License Number State | MN
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