Provider Demographics
NPI:1437103173
Name:LEWIS FARRELL, DIANE E (L AC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:E
Last Name:LEWIS FARRELL
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1472 BRUNSWICK RD
Mailing Address - Street 2:
Mailing Address - City:HARRIS
Mailing Address - State:MN
Mailing Address - Zip Code:55032-3807
Mailing Address - Country:US
Mailing Address - Phone:763-689-2961
Mailing Address - Fax:
Practice Address - Street 1:206 ASHLAND ST S
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1517
Practice Address - Country:US
Practice Address - Phone:763-689-2961
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1037171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist