Healthcare Provider Details

I. General information

NPI: 1184922866
Provider Name (Legal Business Name): MEGAN MARIE NIELSEN L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 HEARST AVE APT A
BERKELEY CA
94710-2077
US

IV. Provider business mailing address

809 HEARST AVE APT A
BERKELEY CA
94710-2077
US

V. Phone/Fax

Practice location:
  • Phone: 510-883-0380
  • Fax:
Mailing address:
  • Phone: 510-883-0380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number13725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: