Provider Demographics
NPI:1437477890
Name:BLUE HERON ACUPUNCTURE AND HERBAL MEDICINE LLC
Entity Type:Organization
Organization Name:BLUE HERON ACUPUNCTURE AND HERBAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:RENAUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-225-1189
Mailing Address - Street 1:63 SCHOOL ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3930
Mailing Address - Country:US
Mailing Address - Phone:603-225-1189
Mailing Address - Fax:
Practice Address - Street 1:63 SCHOOL ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3930
Practice Address - Country:US
Practice Address - Phone:603-225-1189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH66171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty