Provider Demographics
NPI:1962041962
Name:GHANI, CARLA MARIE (LAC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:MARIE
Last Name:GHANI
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 1:2901 FRANCE AVE N
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-3205
Mailing Address - Country:US
Mailing Address - Phone:612-845-7990
Mailing Address - Fax:
Practice Address - Street 1:2901 FRANCE AVE N
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-3205
Practice Address - Country:US
Practice Address - Phone:612-845-7990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1158171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty