MEDICARE: DR. AMANDA Z FREED 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	2089	MN

General Provider Information

NPI Number	:	1508684655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA Z FREED L.AC.

Provider Business Mailing Address
First Line	:	49 S DEEP LAKE RD
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55127-6312
Country	:	US
Telephone Number	:	612-296-3796
Fax Number	:

Provider Business Practice Location Address
First Line	:	49 S DEEP LAKE RD
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55127-6312
Country	:	US
Telephone Number	:	612-296-3796
Fax Number	:

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

Provider Enumeration Date	:	09/27/2024
Last Update Date	:	09/27/2024

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