Provider Demographics
NPI:1679947188
Name:YANCELSON, ELIZABETH LAUREN (DAC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LAUREN
Last Name:YANCELSON
Suffix:
Gender:F
Credentials:DAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2708
Mailing Address - Country:US
Mailing Address - Phone:207-274-8781
Mailing Address - Fax:
Practice Address - Street 1:94 RICHARDSON ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-3004
Practice Address - Country:US
Practice Address - Phone:207-200-7317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-20
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC530171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist