Healthcare Provider Details

I. General information

NPI: 1013019256
Provider Name (Legal Business Name): FERN TSAO AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BENNETT RD
YARMOUTH ME
04096-6757
US

IV. Provider business mailing address

PO BOX 798
YARMOUTH ME
04096-0798
US

V. Phone/Fax

Practice location:
  • Phone: 207-846-4433
  • Fax:
Mailing address:
  • Phone: 207-846-4433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC9
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: