Provider Demographics
NPI:1033457320
Name:GRAMS, SHANA (LAC)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:GRAMS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E BROADWAY
Mailing Address - Street 2:APT 103
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-3099
Mailing Address - Country:US
Mailing Address - Phone:320-583-0093
Mailing Address - Fax:
Practice Address - Street 1:104 KIDDER ST SE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3029
Practice Address - Country:US
Practice Address - Phone:320-583-0093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1639171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist