Healthcare Provider Details

I. General information

NPI: 1356480560
Provider Name (Legal Business Name): CHERYL ENSING LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 N 4TH ST SUITE 104
MOUNT VERNON WA
98273-2856
US

IV. Provider business mailing address

PO BOX 141
MOUNT VERNON WA
98273-0141
US

V. Phone/Fax

Practice location:
  • Phone: 360-336-2794
  • Fax:
Mailing address:
  • Phone: 360-336-2794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC0001816
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: