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NPI Code Detail

MEDICARE: MRS. COLLEEN PATRICE O'BRIEN L.AC.

MEDICARE:  MRS. COLLEEN PATRICE O'BRIEN  L.AC.
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
1171100000XAcupuncturist1459MN

General Provider Information

NPI Number : 1245310754
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. COLLEEN PATRICE O'BRIEN L.AC.
Provider Business Mailing Address
First Line : 446 BEAR AVE S
Second Line :
City : VADNAIS HEIGHTS
State : MN
Zip : 55127-7003
Country : US
Telephone Number : 651-330-9392
Fax Number :
Provider Business Practice Location Address
First Line : 4801 HIGHWAY 61 N STE 307
Second Line :
City : WHITE BEAR LAKE
State : MN
Zip : 55110-2753
Country : US
Telephone Number : 612-741-3284
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2006
Last Update Date : 04/01/2010

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Directions to “ MRS. COLLEEN PATRICE O'BRIEN L.AC.” Practice Location

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