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General NPI Number Information
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NPI Number | 1912691924
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Entity Type | Organization
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Legal Business Name | SERENITY WATERS ACUPUNCTURE, LLC
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 125 PLEASANT ST SW STE A
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City | VIENNA
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State | VA
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Zip | 22180-4443
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Country | US
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Telephone | 571-234-1013
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 FIRST ST APT 730
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City | ALEXANDRIA
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State | VA
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Zip | 22314-1682
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Country | US
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Telephone | 920-382-0309
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Fax |
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Authorized Official
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Title or Position | OWNER/ACUPUNCTURIST
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Name | ERICKA SCHAEFER
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Credential | L.AC.
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Telephone | 920-382-0309
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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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