Provider Demographics
NPI:1053637876
Name:VON VOSS, JACQUELINE ROSA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ROSA
Last Name:VON VOSS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:ROSA
Other - Last Name:FLISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:145 ISLAND CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21617-2454
Mailing Address - Country:US
Mailing Address - Phone:410-200-0678
Mailing Address - Fax:
Practice Address - Street 1:818 HIGH ST
Practice Address - Street 2:SUITE # 4
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1152
Practice Address - Country:US
Practice Address - Phone:410-200-0678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU-01711171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist