Active NPI
Beth Vanwyngarden, L.A.C., MAOM
- Acupuncturist
- Edina, MN
National Provider Identifier
1801294087
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 1747
- Practice address
- 4570 W 77TH St
Suite 140
Edina, MN 55435-5008 - Phone
- (612) 886-7763
- NPI assigned
- Dec 20, 2014
- Last updated
- Sep 11, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 1747 | MN | Primary |
Addresses
Primary practice location
4570 W 77TH St
Suite 140
Edina, MN 55435-5008
Mailing address
PO Box 13487
Salem, OR 97309-1487
Phone (503) 798-2918
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1747 | MN | MD | Acupuncturist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lilac Wellness | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Lilac Wellness and Counseling
- Multi-Specialty Clinic/Center
- Salem, OR
- NPI 1104322841
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1419033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599782400000",
"number": "1801294087",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 13487",
"city": "SALEM",
"state": "OR",
"postal_code": "973091487",
"telephone_number": "503-798-2918"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4570 W 77TH ST",
"address_2": "SUITE 140",
"city": "EDINA",
"state": "MN",
"postal_code": "554355008",
"telephone_number": "612-886-7763"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANWYNGARDEN",
"first_name": "BETH",
"credential": "L.A.C., MAOM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-12-20",
"last_updated": "2020-09-11",
"certification_date": "2020-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "MN",
"license": "1747",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edina, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.