Healthcare Provider Details

I. General information

NPI: 1225263486
Provider Name (Legal Business Name): LUCY RICARDO LARSEN L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 05/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 TURKEYSAG TRAIL
PALMYRA VA
22963
US

IV. Provider business mailing address

33 TIFFANY LANE
FABER VA
22938
US

V. Phone/Fax

Practice location:
  • Phone: 434-591-0900
  • Fax: 866-836-8883
Mailing address:
  • Phone: 434-361-1518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0121000551
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: