MEDICARE: KATHERINE COFFEY-DIETZ ACUPUNCTURIST

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	1742	MN

General Provider Information

NPI Number	:	1629751383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE COFFEY-DIETZ ACUPUNCTURIST

Provider Business Mailing Address
First Line	:	3546 DAKOTA AVE S STE B
Second Line	:
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55416-2331
Country	:	US
Telephone Number	:	952-417-6433
Fax Number	:

Provider Business Practice Location Address
First Line	:	3546 DAKOTA AVE S STE B
Second Line	:
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55416-2331
Country	:	US
Telephone Number	:	952-417-6433
Fax Number	:

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

Provider Enumeration Date	:	08/09/2023
Last Update Date	:	08/09/2023

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Directions to “ KATHERINE COFFEY-DIETZ ACUPUNCTURIST” Practice Location

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