Provider Demographics
NPI:1629751383
Name:COFFEY-DIETZ, KATHERINE (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:COFFEY-DIETZ
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3546 DAKOTA AVE S STE B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2331
Mailing Address - Country:US
Mailing Address - Phone:952-417-6433
Mailing Address - Fax:
Practice Address - Street 1:3546 DAKOTA AVE S STE B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2331
Practice Address - Country:US
Practice Address - Phone:952-417-6433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1742171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist