Provider Demographics
NPI:1427130467
Name:GREWELL, BRENDA GAIL (L AC)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:GAIL
Last Name:GREWELL
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 LOUISA AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNDS VIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55112
Mailing Address - Country:US
Mailing Address - Phone:612-850-1305
Mailing Address - Fax:763-780-6207
Practice Address - Street 1:2650 LOUISA AVE
Practice Address - Street 2:
Practice Address - City:MOUNDS VIEW
Practice Address - State:MN
Practice Address - Zip Code:55112
Practice Address - Country:US
Practice Address - Phone:612-850-1305
Practice Address - Fax:763-780-6207
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1204171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist