MEDICARE: MISS MARIGRACE MCNAMARA RN, 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	AP 1485	FL

General Provider Information

NPI Number	:	1982804415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARIGRACE MCNAMARA RN, L.AC

Provider Business Mailing Address
First Line	:	PO BOX 2012
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32756-2012
Country	:	US
Telephone Number	:	352-735-0979
Fax Number	:	352-735-4772

Provider Business Practice Location Address
First Line	:	1416 N DONNELLY ST
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-2814
Country	:	US
Telephone Number	:	352-735-0979
Fax Number	:	352-735-4772

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

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	07/23/2007

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