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General NPI Number Information
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NPI Number | 1710219423
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Entity Type | Individual
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Provider Name | KRISTINA A. RYAN MAC,LAC
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Gender | Female
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Dates
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Enumeration Date | 02/04/2010
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Last Update Date | 02/04/2010
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Provider Practice Location Address
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Address Line | 1719 MASSACHUSETTS AVE
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City | LEXINGTON
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State | MA
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Zip | 02420-5306
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Country | US
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Telephone | 781-910-5927
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Fax |
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Provider Business Mailing Address
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Address Line | 10 SWEET BAY LN
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City | LINCOLN
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State | MA
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Zip | 01773-4705
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Country | US
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Telephone | 781-259-8440
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Fax | 781-259-8466
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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 | 235319
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License Number State | MA
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