Provider Demographics
NPI:1225278898
Name:MOONEN, ANDREA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:MOONEN
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 1:5715 TRACY AVE
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-2234
Mailing Address - Country:US
Mailing Address - Phone:952-926-0680
Mailing Address - Fax:
Practice Address - Street 1:5715 TRACY AVE
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436-2234
Practice Address - Country:US
Practice Address - Phone:952-926-0680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1385171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist