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General NPI Number Information
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NPI Number | 1699232660
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Entity Type | Organization
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Legal Business Name | ACUPUNCTURE NIRVANA
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Dates
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Enumeration Date | 02/26/2019
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Last Update Date | 02/26/2019
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Provider Practice Location Address
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Address Line | 451 GLEN ST
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City | GLENS FALLS
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State | NY
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Zip | 12801-2905
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Country | US
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Telephone | 518-409-6993
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Fax | 518-615-1251
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Provider Business Mailing Address
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Address Line | 451 GLEN ST
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City | GLENS FALLS
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State | NY
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Zip | 12801-2905
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Country | US
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Telephone | 518-409-6993
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Fax | 518-615-1251
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Authorized Official
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Title or Position | OWNER
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Name | MS. KATHERINE A. MACKENZIE
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Credential | LAC
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Telephone | 518-409-6993
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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 |
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License Number State |
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