Provider Demographics
NPI:1043582828
Name:BOWMAN, KATIE MARIE MOKSNES (LAC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE MOKSNES
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:MARIE
Other - Last Name:MOKSNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34 WATER ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-1846
Mailing Address - Country:US
Mailing Address - Phone:612-501-7171
Mailing Address - Fax:
Practice Address - Street 1:34 WATER ST
Practice Address - Street 2:SUITE B
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-1846
Practice Address - Country:US
Practice Address - Phone:612-501-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC155869171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist