Provider Demographics
NPI:1144663808
Name:KIEWEL, ELIZABETH (MT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:KIEWEL
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 13TH STREET SOUTH
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:327 13TH STREET SOUTH
Practice Address - Street 2:SUITE 110
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328
Practice Address - Country:US
Practice Address - Phone:952-686-8682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-12
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1144663808OtherNON