MEDICARE: MS. CASSANDRA KAY ROBERSON 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	1136	MN

General Provider Information

NPI Number	:	1639257801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CASSANDRA KAY ROBERSON L.AC.

Provider Business Mailing Address
First Line	:	4533 LOUISIANA AVE N
Second Line	:
City	:	CRYSTAL
State	:	MN
Zip	:	55428-5026
Country	:	US
Telephone Number	:	763-536-9350
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 LYNDALE AVE S STE E
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2152
Country	:	US
Telephone Number	:	763-536-9350
Fax Number	:

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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