Healthcare Provider Details

I. General information

NPI: 1700385051
Provider Name (Legal Business Name): LAURA C. ELLIS L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 09/15/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2469 EVANS CITY RD.
HARMONY PA
16037-6811
US

IV. Provider business mailing address

2469 EVANS CITY RD
HARMONY PA
16037-9116
US

V. Phone/Fax

Practice location:
  • Phone: 724-453-4335
  • Fax:
Mailing address:
  • Phone: 724-453-4335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberOM000204
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: