Provider Demographics
NPI:1104012624
Name:KRAUSE READER, AMY MARIE (L AC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:KRAUSE READER
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 LAKEWOOD DR S
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55119-5522
Mailing Address - Country:US
Mailing Address - Phone:651-735-0165
Mailing Address - Fax:
Practice Address - Street 1:1158 THOMAS AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2165
Practice Address - Country:US
Practice Address - Phone:651-398-8651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1379171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist