Provider Demographics
NPI:1831659895
Name:VEDELER, ANNIE (LAC)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:VEDELER
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 1:9832 N HAYDEN RD STE 215
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-1235
Mailing Address - Country:US
Mailing Address - Phone:480-359-7389
Mailing Address - Fax:
Practice Address - Street 1:9832 N HAYDEN RD STE 215
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-1235
Practice Address - Country:US
Practice Address - Phone:480-359-7389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-24
Last Update Date:2019-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ010046171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist