Provider Demographics
NPI:1639397235
Name:MARLAND, MIRANDA (LAC)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:MARLAND
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 FUNDY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1764
Mailing Address - Country:US
Mailing Address - Phone:207-781-7600
Mailing Address - Fax:
Practice Address - Street 1:4 FUNDY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1764
Practice Address - Country:US
Practice Address - Phone:207-781-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEACU00002171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist