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General NPI Number Information
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NPI Number | 1790433605
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Entity Type | Individual
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Provider Name | MANDIE ELLIS DAOM
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Gender | Female
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Dates
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Enumeration Date | 03/10/2022
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 1991 VICTORY HWY
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City | GLENDALE
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State | RI
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Zip | 02826-1670
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Country | US
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Telephone | 401-710-4207
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Fax |
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Provider Business Mailing Address
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Address Line | 153 WOODSTOCK AVE
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City | PUTNAM
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State | CT
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Zip | 06260-1429
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Country | US
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Telephone | 978-798-8804
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Fax |
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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 | DAOM00088
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License Number State | RI
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