Provider Demographics
NPI:1336288828
Name:PLOURDE, SERRA MAY (LIC AC)
Entity Type:Individual
Prefix:
First Name:SERRA MAY
Middle Name:
Last Name:PLOURDE
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 ROMOLA RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3824
Mailing Address - Country:US
Mailing Address - Phone:508-792-6566
Mailing Address - Fax:
Practice Address - Street 1:232 CHANDLER ST
Practice Address - Street 2:SUITE B
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2940
Practice Address - Country:US
Practice Address - Phone:508-792-6566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219167171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist