Provider Demographics
NPI:1013981661
Name:MCGLENNEN, DONA (LAC)
Entity Type:Individual
Prefix:
First Name:DONA
Middle Name:
Last Name:MCGLENNEN
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 1:1024 PARKER AVE
Mailing Address - Street 2:2201 LEXINGTON AVE. NO.
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6459
Mailing Address - Country:US
Mailing Address - Phone:612-432-3014
Mailing Address - Fax:
Practice Address - Street 1:1024 PARKER AVE
Practice Address - Street 2:2201 LEXINGTON AVE. NO.
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-6459
Practice Address - Country:US
Practice Address - Phone:612-432-3014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1521171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist