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General NPI Number Information
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NPI Number | 1316291149
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Entity Type | Individual
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Provider Name | GLENNA MAPLE L.AC., R.N.
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Gender | Female
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Dates
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Enumeration Date | 10/31/2012
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Last Update Date | 07/18/2013
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Provider Practice Location Address
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Address Line | 1101 S WINCHESTER BLVD SUITE N-267
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City | SAN JOSE
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State | CA
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Zip | 95128-3901
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Country | US
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Telephone | 408-314-9830
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Fax |
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Provider Business Mailing Address
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Address Line | 22285 S DE ANZA CIR
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City | CUPERTINO
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State | CA
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Zip | 95014-3952
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Country | US
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Telephone | 408-257-7651
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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 | AC 14977
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License Number State | CA
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