Provider Demographics
NPI:1992124184
Name:VAN OSTRAND, AIMEE
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:VAN OSTRAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3738 AUGER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-4617
Mailing Address - Country:US
Mailing Address - Phone:651-295-1950
Mailing Address - Fax:
Practice Address - Street 1:2189 4TH ST STE 2
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3043
Practice Address - Country:US
Practice Address - Phone:651-295-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1676171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist