Healthcare Provider Details

I. General information

NPI: 1366775454
Provider Name (Legal Business Name): ELENI ALEXANDRA POURNARAS M.AC., L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 09/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 S GEORGE ST
YORK PA
17403-3123
US

IV. Provider business mailing address

1175 FAIRVIEW DR
YORK PA
17403-3611
US

V. Phone/Fax

Practice location:
  • Phone: 717-578-2068
  • Fax:
Mailing address:
  • Phone: 717-578-2068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAK000963
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: