Healthcare Provider Details

I. General information

NPI: 1881840551
Provider Name (Legal Business Name): STEPHANIE BAIRD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 SAINT JOHN ST STE 226
PORTLAND ME
04102-3058
US

IV. Provider business mailing address

222 SAINT JOHN ST STE 226
PORTLAND ME
04102-3058
US

V. Phone/Fax

Practice location:
  • Phone: 207-871-5060
  • Fax: 207-839-2197
Mailing address:
  • Phone: 207-871-5060
  • Fax: 207-839-2197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC159
License Number StateME

VIII. Authorized Official

Name: STEPHANIE BAIRD
Title or Position: OWNER/PROVIDER
Credential: ACUPUNCTURIST
Phone: 207-871-5060