Provider Demographics
NPI:1053732271
Name:BOURQUIN, DANETTE (LAC)
Entity type:Individual
Prefix:
First Name:DANETTE
Middle Name:
Last Name:BOURQUIN
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 1:607 N LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:FULDA
Mailing Address - State:MN
Mailing Address - Zip Code:56131-9201
Mailing Address - Country:US
Mailing Address - Phone:507-227-5873
Mailing Address - Fax:
Practice Address - Street 1:607 N LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:FULDA
Practice Address - State:MN
Practice Address - Zip Code:56131-9201
Practice Address - Country:US
Practice Address - Phone:507-227-5873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1691171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist