Provider Demographics
NPI:1881967461
Name:MUTSCHLER, CHERYL LYNN (LAC)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:MUTSCHLER
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 1:6421 WARREN AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-1245
Mailing Address - Country:US
Mailing Address - Phone:952-220-0193
Mailing Address - Fax:
Practice Address - Street 1:6421 WARREN AVE S
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-1245
Practice Address - Country:US
Practice Address - Phone:952-220-0193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1143171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist