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General NPI Number Information
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NPI Number | 1417390006
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Entity Type | Organization
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Legal Business Name | KARA GRANDEA ACUPUNCTURE & WELLNESS, LLC
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Dates
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Enumeration Date | 04/12/2013
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Last Update Date | 03/02/2017
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Provider Practice Location Address
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Address Line | 8182 LARK BROWN RD SUITE 102
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City | ELKRIDGE
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State | MD
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Zip | 21075-6428
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Country | US
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Telephone | 410-375-9607
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Fax |
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Provider Business Mailing Address
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Address Line | 8382 MONTGOMERY RUN RD F
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City | ELLICOTT CITY
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State | MD
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Zip | 21043-7246
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Country | US
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Telephone | 410-375-9607
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KARA GRANDEA
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Credential | M.O.M, L.AC.
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Telephone | 410-375-9607
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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 | U01966
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License Number State | MD
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