Provider Demographics
NPI:1669567913
Name:WINER, JENNIFER E (LAC,DIPLAC, MSOM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:WINER
Suffix:
Gender:F
Credentials:LAC,DIPLAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10551 GREENBRIER RD APT 312
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-3462
Mailing Address - Country:US
Mailing Address - Phone:612-226-8840
Mailing Address - Fax:
Practice Address - Street 1:715 FLORIDA AVE SO SUITE 206
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1380
Practice Address - Country:US
Practice Address - Phone:612-226-8840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1269171100000X
WI370-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist