Provider Demographics
NPI:1063836906
Name:KURETSKY, AMY (LAC, MOM, DIPLOM)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KURETSKY
Suffix:
Gender:F
Credentials:LAC, MOM, DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 LOWRY AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-3628
Mailing Address - Country:US
Mailing Address - Phone:612-276-2695
Mailing Address - Fax:
Practice Address - Street 1:800 LOWRY AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-3628
Practice Address - Country:US
Practice Address - Phone:612-276-2695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1697171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist