=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063949063
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTIN LUNDEEN GRIZZELL D.AC.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2017
-----------------------------------------------------
Last Update Date | 02/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2139 ESPEY CT STE 4
-----------------------------------------------------
City | CROFTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21114-2446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-584-3047
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 687 DISCOVERY CT
-----------------------------------------------------
City | DAVIDSONVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21035-1324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-584-3047
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | U02129
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------