Provider Demographics
NPI:1942732987
Name:PLANTENBERG, HILARY ANN
Entity Type:Individual
Prefix:
First Name:HILARY
Middle Name:ANN
Last Name:PLANTENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26150 TUCKER RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-9161
Mailing Address - Country:US
Mailing Address - Phone:763-234-0844
Mailing Address - Fax:
Practice Address - Street 1:1865 W WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:LONG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55356-9671
Practice Address - Country:US
Practice Address - Phone:763-234-0844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1846171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist