MEDICARE: KATIE MARIE MOKSNES BOWMAN LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC155869	OR

General Provider Information

NPI Number	:	1043582828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE MARIE MOKSNES BOWMAN LAC

Provider Business Mailing Address
First Line	:	34 WATER ST
Second Line	:	SUITE B
City	:	EXCELSIOR
State	:	MN
Zip	:	55331-1846
Country	:	US
Telephone Number	:	612-501-7171
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 WATER ST
Second Line	:	SUITE B
City	:	EXCELSIOR
State	:	MN
Zip	:	55331-1846
Country	:	US
Telephone Number	:	612-501-7171
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2012
Last Update Date	:	12/16/2016

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Directions to “ KATIE MARIE MOKSNES BOWMAN LAC” Practice Location

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