Provider Demographics
NPI:1619006806
Name:PROKOPIUK, EWA (MAC,LAC)
Entity Type:Individual
Prefix:MS
First Name:EWA
Middle Name:
Last Name:PROKOPIUK
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:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-0184
Mailing Address - Country:US
Mailing Address - Phone:207-563-6607
Mailing Address - Fax:207-563-6607
Practice Address - Street 1:17 VINE ST.
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543
Practice Address - Country:US
Practice Address - Phone:207-563-6607
Practice Address - Fax:207-563-6607
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC154171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME018331MEOtherANTHEM BCBS