Provider Demographics
NPI:1922642594
Name:STEFFES, KATRINA (LAC)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:STEFFES
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 1:4101 W BROADWAY AVE STE D
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-1859
Mailing Address - Country:US
Mailing Address - Phone:763-533-9997
Mailing Address - Fax:
Practice Address - Street 1:4101 W BROADWAY AVE STE D
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-1859
Practice Address - Country:US
Practice Address - Phone:763-533-9997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1933171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1093086696OtherINSURANCE PROVIDER