Provider Demographics
NPI:1376800276
Name:SANDVEN, EMILY (AAS MASSAGE)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SANDVEN
Suffix:
Gender:F
Credentials:AAS MASSAGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 PAGE ST SW
Mailing Address - Street 2:
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040-7235
Mailing Address - Country:US
Mailing Address - Phone:763-210-8329
Mailing Address - Fax:
Practice Address - Street 1:807 MAIN ST N
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1275
Practice Address - Country:US
Practice Address - Phone:763-552-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist