Provider Demographics
NPI:1669779625
Name:REYNA, SARAH JEAN (LAC)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:JEAN
Last Name:REYNA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:JEAN
Other - Last Name:SAWYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:45 BAKER ST E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-2972
Mailing Address - Country:US
Mailing Address - Phone:651-769-7641
Mailing Address - Fax:
Practice Address - Street 1:45 BAKER ST E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-2972
Practice Address - Country:US
Practice Address - Phone:651-769-7641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-26
Last Update Date:2018-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1512171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist