Provider Demographics
NPI:1649598608
Name:RENAUD, KARLA (LICAC)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:RENAUD
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 SCHOOL ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3930
Mailing Address - Country:US
Mailing Address - Phone:603-225-1189
Mailing Address - Fax:
Practice Address - Street 1:63 SCHOOL ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3930
Practice Address - Country:US
Practice Address - Phone:603-225-1189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216024171100000X
NH66171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist