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General NPI Number Information
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NPI Number | 1699896837
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Entity Type | Individual
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Provider Name | MARTHA JEAN PAINTER L.AC.
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Gender | Female
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1000 WILLOW CREEK RD SUITE A
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City | PRESCOTT
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State | AZ
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Zip | 86301-1645
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Country | US
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Telephone | 928-776-4895
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Fax | 928-776-4895
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Provider Business Mailing Address
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Address Line | 1042 WILLOW CREEK RD A101-457
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City | PRESCOTT
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State | AZ
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Zip | 86301-1673
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Country | US
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Telephone | 928-776-4895
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Fax | 928-776-4903
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0359
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License Number State | AZ
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