Healthcare Provider Details

I. General information

NPI: 1982762068
Provider Name (Legal Business Name): JANE MELROSE L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 EAGLES REST RD
SHELBURNE VT
05482-7624
US

IV. Provider business mailing address

107 EAGLES REST RD
SHELBURNE VT
05482-7624
US

V. Phone/Fax

Practice location:
  • Phone: 802-985-5833
  • Fax: 802-985-2385
Mailing address:
  • Phone: 802-985-5833
  • Fax: 802-985-2385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number091-0000186
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: