Provider Demographics
NPI:1033435227
Name:LASOTA, COLLEEN ELIZABETH (LAC)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:ELIZABETH
Last Name:LASOTA
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 1:4205 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3122
Mailing Address - Country:US
Mailing Address - Phone:347-306-2618
Mailing Address - Fax:
Practice Address - Street 1:4100 GRAND AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55409-1576
Practice Address - Country:US
Practice Address - Phone:347-306-2618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004124171100000X
MN1572171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist