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General NPI Number Information
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NPI Number | 1770937906
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Entity Type | Organization
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Legal Business Name | WHITE OAK ACUPUNCTURE LLC
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Dates
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Enumeration Date | 04/13/2016
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Last Update Date | 04/13/2016
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Provider Practice Location Address
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Address Line | 23624 SAINT FRANCIS BLVD NW STE 1
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City | SAINT FRANCIS
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State | MN
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Zip | 55070-5501
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Country | US
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Telephone | 612-516-4386
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Fax | 888-333-1427
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Provider Business Mailing Address
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Address Line | 2365 LAKE GEORGE DR NW
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City | CEDAR
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State | MN
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Zip | 55011-4216
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Country | US
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Telephone | 612-516-4386
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Fax | 888-333-1427
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Authorized Official
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Title or Position | OWNER/ LICENSED ACUPUNCTURIST
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Name | RACHEL SIMONE NUDD
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Credential | LAC
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Telephone | 612-516-4386
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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 | 1594
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License Number State | MN
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