Provider Demographics
NPI:1124328372
Name:TANNING, DIANE (LAC, MS)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:TANNING
Suffix:
Gender:F
Credentials:LAC, MS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10505 WAYZATA BLVD.,
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1506
Mailing Address - Country:US
Mailing Address - Phone:763-546-5797
Mailing Address - Fax:763-546-5754
Practice Address - Street 1:10505 WAYZATA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1502
Practice Address - Country:US
Practice Address - Phone:763-546-5797
Practice Address - Fax:763-546-5754
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN1323171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist