MEDICARE: MRS. VICKY LYNN RADEL R.N., 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	1071	MN

General Provider Information

NPI Number	:	1699804047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICKY LYNN RADEL R.N., L. AC.

Provider Business Mailing Address
First Line	:	6311 WAYZATA BLVD
Second Line	:	SUITE 210
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1209
Country	:	US
Telephone Number	:	952-545-0200
Fax Number	:	952-545-6388

Provider Business Practice Location Address
First Line	:	6311 WAYZATA BLVD
Second Line	:	SUITE 210
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1209
Country	:	US
Telephone Number	:	952-545-0200
Fax Number	:	952-545-6388

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

Provider Enumeration Date	:	03/03/2007
Last Update Date	:	07/08/2007

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