Provider Demographics
NPI:1518127257
Name:DELAURA, STACEY A (LIC AC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:A
Last Name:DELAURA
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 1:7 TURNER RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-1541
Mailing Address - Country:US
Mailing Address - Phone:508-264-3580
Mailing Address - Fax:
Practice Address - Street 1:7 TURNER RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-1541
Practice Address - Country:US
Practice Address - Phone:508-264-3580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA590171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist