Healthcare Provider Details

I. General information

NPI: 1417343658
Provider Name (Legal Business Name): TAMMY MARIA LALONDE L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12820 107 AVE NW
EDMONTON AB
T5M 1Z9
CA

IV. Provider business mailing address

12820 107 AVE NW
EDMONTON AB
T5M 1Z9
CA

V. Phone/Fax

Practice location:
  • Phone: 780-633-7538
  • Fax:
Mailing address:
  • Phone: 780-633-7538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: