Provider Demographics
NPI:1336929405
Name:FUMIA, KRISTINE FASNACHT (LAC)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:FASNACHT
Last Name:FUMIA
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:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:MADISON LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56063-0094
Mailing Address - Country:US
Mailing Address - Phone:507-373-0009
Mailing Address - Fax:
Practice Address - Street 1:513 MAIN STREET
Practice Address - Street 2:STE 1
Practice Address - City:MADISON LAKE
Practice Address - State:MN
Practice Address - Zip Code:56063
Practice Address - Country:US
Practice Address - Phone:507-737-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH240173C00000X
MN2041171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No173C00000XOther Service ProvidersReflexologist