Provider Demographics
NPI:1215303177
Name:TATERKA, JANET LOUISE (MS LAC)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:LOUISE
Last Name:TATERKA
Suffix:
Gender:F
Credentials:MS LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 25TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2635
Mailing Address - Country:US
Mailing Address - Phone:651-278-7920
Mailing Address - Fax:
Practice Address - Street 1:1055 25TH AVE SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-2635
Practice Address - Country:US
Practice Address - Phone:651-278-7920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1556171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist