Healthcare Provider Details

I. General information

NPI: 1386783207
Provider Name (Legal Business Name): LAURA L LEVENSALER RN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA LAROCHE

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 MAIN ST SUITE 5 ACUPUNCTURE PLUS INC
WALTHAM MA
02451-0620
US

IV. Provider business mailing address

3 REVERE RD
WOBURN MA
01801-4729
US

V. Phone/Fax

Practice location:
  • Phone: 781-891-7587
  • Fax: 781-933-1389
Mailing address:
  • Phone: 781-891-7587
  • Fax: 781-933-1389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number212
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: