Provider Demographics
NPI:1518565605
Name:GRATITUDE FOR WELLNESS ACUPUNCTURE
Entity Type:Organization
Organization Name:GRATITUDE FOR WELLNESS ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:MAKI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:802-349-6295
Mailing Address - Street 1:PO BOX 805
Mailing Address - Street 2:
Mailing Address - City:WILLSBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12996-0805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17 CEDAR LANE
Practice Address - Street 2:
Practice Address - City:WILLSBORO
Practice Address - State:NY
Practice Address - Zip Code:12996
Practice Address - Country:US
Practice Address - Phone:802-349-6295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty