MEDICARE: HAYLEY RAE ALT 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	2054	MN

General Provider Information

NPI Number	:	1902683782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAYLEY RAE ALT L.AC.

Provider Business Mailing Address
First Line	:	7084 CENTERVILLE RD
Second Line	:
City	:	CENTERVILLE
State	:	MN
Zip	:	55038-9712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	744 WILDWOOD RD
Second Line	:
City	:	MAHTOMEDI
State	:	MN
Zip	:	55115-1852
Country	:	US
Telephone Number	:	651-300-2350
Fax Number	:

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

Provider Enumeration Date	:	09/13/2023
Last Update Date	:	04/15/2024

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Directions to “ HAYLEY RAE ALT L.AC.” Practice Location

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