Provider Demographics
NPI:1144710906
Name:SANDBERG, DONNA DENISE (LAC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:DENISE
Last Name:SANDBERG
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 1:5210 VILLA WAY APT 358
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-2150
Mailing Address - Country:US
Mailing Address - Phone:612-250-9261
Mailing Address - Fax:
Practice Address - Street 1:4330 CEDAR LAKE RD S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-3700
Practice Address - Country:US
Practice Address - Phone:612-250-9261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1852171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist