Provider Demographics
NPI:1376915876
Name:OSVOLD, ANDREA ELIZABETH (MAC, LAC)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:ELIZABETH
Last Name:OSVOLD
Suffix:
Gender:F
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14389 SHORE LN NE
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-1253
Mailing Address - Country:US
Mailing Address - Phone:218-260-6218
Mailing Address - Fax:
Practice Address - Street 1:1523 SELBY AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6304
Practice Address - Country:US
Practice Address - Phone:651-207-3019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1777171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist