MEDICARE: MS. STEPHANIE LYNN MALL L.AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	2009013025	MO

General Provider Information

NPI Number	:	1427280890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE LYNN MALL L.AC.

Provider Business Mailing Address
First Line	:	1810 SUMMIT ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-2109
Country	:	US
Telephone Number	:	913-221-8410
Fax Number	:

Provider Business Practice Location Address
First Line	:	1810 SUMMIT ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-2109
Country	:	US
Telephone Number	:	913-221-8410
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2009
Last Update Date	:	11/02/2011

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