MEDICARE: DR. ANGELA JEAN WEBER DCM

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	1918	MN

General Provider Information

NPI Number	:	1801417647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA JEAN WEBER DCM

Provider Business Mailing Address
First Line	:	1611 W WAYZATA BLVD
Second Line	:
City	:	LONG LAKE
State	:	MN
Zip	:	55356-9300
Country	:	US
Telephone Number	:	952-222-8158
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 W WAYZATA BLVD
Second Line	:
City	:	LONG LAKE
State	:	MN
Zip	:	55356-9300
Country	:	US
Telephone Number	:	952-222-8158
Fax Number	:

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

Provider Enumeration Date	:	05/04/2020
Last Update Date	:	05/04/2020

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