Provider Demographics
NPI:1770937906
Name:WHITE OAK ACUPUNCTURE LLC
Entity type:Organization
Organization Name:WHITE OAK ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:SIMONE
Authorized Official - Last Name:NUDD
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:612-516-4386
Mailing Address - Street 1:2365 LAKE GEORGE DR NW
Mailing Address - Street 2:
Mailing Address - City:CEDAR
Mailing Address - State:MN
Mailing Address - Zip Code:55011-4216
Mailing Address - Country:US
Mailing Address - Phone:612-516-4386
Mailing Address - Fax:888-333-1427
Practice Address - Street 1:23624 SAINT FRANCIS BLVD NW STE 1
Practice Address - Street 2:
Practice Address - City:SAINT FRANCIS
Practice Address - State:MN
Practice Address - Zip Code:55070-5501
Practice Address - Country:US
Practice Address - Phone:612-516-4386
Practice Address - Fax:888-333-1427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1594171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty