Provider Demographics
NPI:1609444116
Name:HORAN, ANNETTE LYNN (LAC)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:LYNN
Last Name:HORAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:WINTER
Other - Last Name:SUDBROOK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2215 SHORE DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-2935
Mailing Address - Country:US
Mailing Address - Phone:443-257-2545
Mailing Address - Fax:
Practice Address - Street 1:2215 SHORE DR
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2935
Practice Address - Country:US
Practice Address - Phone:443-257-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-12
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02782171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist