Healthcare Provider Details

I. General information

NPI: 1457514291
Provider Name (Legal Business Name): ANN-MARIE YEAGER MSOM, L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 E 4TH ST STE 106
LOVELAND CO
80537-5653
US

IV. Provider business mailing address

811 E 5TH ST
LOVELAND CO
80537-5745
US

V. Phone/Fax

Practice location:
  • Phone: 970-663-4548
  • Fax:
Mailing address:
  • Phone: 970-663-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1042
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: