Provider Demographics
NPI:1578632949
Name:DENISON, MARY ELIZABETH KRAKER (LAC, DIPLOM, MOM)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH KRAKER
Last Name:DENISON
Suffix:
Gender:F
Credentials:LAC, DIPLOM, MOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 30TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-1308
Mailing Address - Country:US
Mailing Address - Phone:612-728-0844
Mailing Address - Fax:612-729-1317
Practice Address - Street 1:4900 30TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-1308
Practice Address - Country:US
Practice Address - Phone:612-728-0844
Practice Address - Fax:612-729-1317
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1122171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist