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General NPI Number Information
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NPI Number | 1326346800
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Entity Type | Organization
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Legal Business Name | TEA HOUSE ACUPUNCTURE LLC
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Dates
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Enumeration Date | 03/07/2011
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Last Update Date | 03/07/2011
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Provider Practice Location Address
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Address Line | 835 GENEVA PKWY N SUITE #3
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City | LAKE GENEVA
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State | WI
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Zip | 53147-5700
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Country | US
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Telephone | 262-248-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 835 GENEVA PKWY N SUITE #3
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City | LAKE GENEVA
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State | WI
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Zip | 53147-5700
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Country | US
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Telephone | 262-248-3800
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JULIANN CAMILLE STERN
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Credential | CA, LAC, MSOM
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Telephone | 262-248-3800
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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 | 706055
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License Number State | WI
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