Provider Demographics
NPI:1407062300
Name:LAUER, DIANE (MAC LAC)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:LAUER
Suffix:
Gender:F
Credentials:MAC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8725 HUMMINGBIRD CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1254
Mailing Address - Country:US
Mailing Address - Phone:301-776-1177
Mailing Address - Fax:
Practice Address - Street 1:3440 ELLICOTT CENTER DR
Practice Address - Street 2:SUITE 202
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043
Practice Address - Country:US
Practice Address - Phone:301-395-9764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01573171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist