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General NPI Number Information
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NPI Number | 1134424690
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Entity Type | Individual
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Provider Name | LISA LLEWELLYN SEVERINO L.AC., M.AC.
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Gender | Female
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Dates
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Enumeration Date | 01/14/2011
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Last Update Date | 01/14/2011
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Provider Practice Location Address
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Address Line | 1446 W PATRICK ST UNIT 14
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City | FREDERICK
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State | MD
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Zip | 21702-3200
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Country | US
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Telephone | 301-606-7657
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Fax |
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Provider Business Mailing Address
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Address Line | 12442 STOTTLEMYER RD
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City | MYERSVILLE
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State | MD
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Zip | 21773-9600
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Country | US
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Telephone | 301-606-7657
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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 | U01720
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License Number State | MD
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