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General NPI Number Information
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NPI Number | 1053900431
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Entity Type | Individual
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Provider Name | NICOLE GABRIELLE LEONEL DACM, L.AC
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Gender | Female
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Dates
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Enumeration Date | 01/11/2021
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Last Update Date | 01/11/2021
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Provider Practice Location Address
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Address Line | 53 OLD SOLOMONS ISLAND RD
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City | ANNAPOLIS
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State | MD
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Zip | 21401-3872
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Country | US
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Telephone | 410-263-0411
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Fax |
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Provider Business Mailing Address
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Address Line | 7112 5TH AVE
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City | RIO LINDA
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State | CA
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Zip | 95673-2251
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | U02789
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License Number State | MD
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