=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366243909
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SACRED HEART ACUPUNCTURE AND WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2025
-----------------------------------------------------
Last Update Date | 03/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33 N MAIN ST
-----------------------------------------------------
City | WOLFEBORO
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03894-4485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-468-7787
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 VINEYARD DR
-----------------------------------------------------
City | STRATHAM
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03885-6529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-468-7787
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED ACUPUNCTURIST
-----------------------------------------------------
Name | DEBORAH YOUNG
-----------------------------------------------------
Credential | AP, L.AC.
-----------------------------------------------------
Telephone | 904-468-7787
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------