Healthcare Provider Details

I. General information

NPI: 1922200831
Provider Name (Legal Business Name): HEIDI MARLENE BRANLUND L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3665 EUREKA WAY
REDDING CA
96001-0177
US

IV. Provider business mailing address

3665 EUREKA WAY
REDDING CA
96001-0177
US

V. Phone/Fax

Practice location:
  • Phone: 530-241-9233
  • Fax:
Mailing address:
  • Phone: 530-241-9233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC8453
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: