MEDICARE: ELIZABETH WILLIS 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
1	171100000X	Acupuncturist	2118	MN

General Provider Information

NPI Number	:	1437013869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH WILLIS L.AC

Provider Business Mailing Address
First Line	:	3824 ZENITH AVE N
Second Line	:
City	:	ROBBINSDALE
State	:	MN
Zip	:	55422-2319
Country	:	US
Telephone Number	:	303-868-1652
Fax Number	:

Provider Business Practice Location Address
First Line	:	4660 SLATER RD STE 145
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55122-4047
Country	:	US
Telephone Number	:	612-367-6150
Fax Number	:

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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