Healthcare Provider Details

I. General information

NPI: 1942487129
Provider Name (Legal Business Name): MS. NINA MACNEILLE VINCENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 MILLER AVE SUITE NUMBER 7
MILL VALLEY CA
94941-2846
US

IV. Provider business mailing address

160 PACIFIC WAY
MUIR BEACH CA
94965-9730
US

V. Phone/Fax

Practice location:
  • Phone: 415-838-0459
  • Fax:
Mailing address:
  • Phone: 415-838-0459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number7447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: