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General NPI Number Information
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NPI Number | 1669708046
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Entity Type | Individual
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Provider Name | CASSIE JO TRENHAILE L.AC.
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Gender | Female
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Dates
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Enumeration Date | 10/20/2009
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Last Update Date | 09/05/2012
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Provider Practice Location Address
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Address Line | 1036 CLEVELAND AVE S
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City | SAINT PAUL
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State | MN
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Zip | 55116-1826
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Country | US
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Telephone | 612-790-5505
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Fax |
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Provider Business Mailing Address
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Address Line | 2724 GARFIELD AVE #1
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-1344
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Country | US
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Telephone | 612-790-5505
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1465
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License Number State | MN
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