Provider Demographics
NPI:1821346347
Name:MINK, KATIE MCELYEA (LAC)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:MCELYEA
Last Name:MINK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 BANCROFT WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-1710
Mailing Address - Country:US
Mailing Address - Phone:510-849-8849
Mailing Address - Fax:510-883-1438
Practice Address - Street 1:1720 BANCROFT WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-1710
Practice Address - Country:US
Practice Address - Phone:510-849-8849
Practice Address - Fax:510-883-1438
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist