Provider Demographics
NPI:1528391208
Name:JEZIORSKI, SHARI MARIE (LAC)
Entity Type:Individual
Prefix:MS
First Name:SHARI
Middle Name:MARIE
Last Name:JEZIORSKI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5372 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1402
Mailing Address - Country:US
Mailing Address - Phone:612-382-0403
Mailing Address - Fax:763-786-6016
Practice Address - Street 1:5372 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55112-1402
Practice Address - Country:US
Practice Address - Phone:612-382-0403
Practice Address - Fax:763-786-6016
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1493171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist