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General NPI Number Information
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NPI Number | 1831498542
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Entity Type | Organization
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Legal Business Name | HOLISTIC PATHWAYS
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Dates
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Enumeration Date | 03/21/2011
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Last Update Date | 03/21/2011
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Provider Practice Location Address
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Address Line | 12203 ABERDEEN ST NE STE 120
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City | BLAINE
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State | MN
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Zip | 55449-5175
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Country | US
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Telephone | 763-639-3595
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Fax |
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Provider Business Mailing Address
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Address Line | 12203 ABERDEEN ST NE STE 120
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City | BLAINE
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State | MN
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Zip | 55449-5175
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | MS. CAROLYN L. BROWN
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Credential | L.AC
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Telephone | 763-639-3595
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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 | 1400
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License Number State | MN
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