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General NPI Number Information
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NPI Number | 1689180986
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Entity Type | Organization
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Legal Business Name | ACUSHARON
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Dates
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Enumeration Date | 12/21/2017
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Last Update Date | 12/31/2017
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Provider Practice Location Address
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Address Line | 251 JEFFERSON ST
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City | WALDOBORO
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State | ME
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Zip | 04572-6011
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Country | US
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Telephone | 207-482-0725
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Fax |
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Provider Business Mailing Address
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Address Line | 17 EAGLE LN
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City | DAMARISCOTTA
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State | ME
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Zip | 04543-4109
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Country | US
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Telephone | 207-482-0725
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Fax |
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Authorized Official
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Title or Position | MASTER OF ACUPUNCTURE
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Name | MS. SHARON A. GORDON
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Credential | L.AC.M.AC., DIPL.AC.
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Telephone | 207-482-0725
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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 | AC364
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License Number State | ME
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