Provider Demographics
NPI:1295971828
Name:SIMENSEN, ELIZABETH (LIC AC MAOM)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SIMENSEN
Suffix:
Gender:F
Credentials:LIC AC MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3061 BLACK BAY RD
Mailing Address - Street 2:
Mailing Address - City:COOK
Mailing Address - State:MN
Mailing Address - Zip Code:55723-8807
Mailing Address - Country:US
Mailing Address - Phone:612-281-7755
Mailing Address - Fax:
Practice Address - Street 1:3061 BLACK BAY RD
Practice Address - Street 2:
Practice Address - City:COOK
Practice Address - State:MN
Practice Address - Zip Code:55723-8807
Practice Address - Country:US
Practice Address - Phone:612-281-7755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-03
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1166171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist