Healthcare Provider Details

I. General information

NPI: 1528509049
Provider Name (Legal Business Name): JADE ALYSEN LANZETTA L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 MONTFORD AVE
ASHEVILLE NC
28801-1051
US

IV. Provider business mailing address

369 MONTFORD AVE
ASHEVILLE NC
28801-1051
US

V. Phone/Fax

Practice location:
  • Phone: 828-258-9016
  • Fax: 828-254-9720
Mailing address:
  • Phone: 828-258-9016
  • Fax: 828-254-9720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number910
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: