Healthcare Provider Details

I. General information

NPI: 1619225588
Provider Name (Legal Business Name): LISA CAROL EAVES L. AC., DIPL. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2012
Last Update Date: 08/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 42ND ST NW STE 301
WASHINGTON DC
20016-4623
US

IV. Provider business mailing address

4545 42ND ST NW STE 301
WASHINGTON DC
20016-4623
US

V. Phone/Fax

Practice location:
  • Phone: 202-244-2289
  • Fax:
Mailing address:
  • Phone: 202-244-2289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC30058
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: