Provider Demographics
NPI:1780866699
Name:WAFER, DAWN MARIE (LAC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:WAFER
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 1:243 GLENNORA WAY
Mailing Address - Street 2:
Mailing Address - City:BUELLTON
Mailing Address - State:CA
Mailing Address - Zip Code:93427-9621
Mailing Address - Country:US
Mailing Address - Phone:805-895-1164
Mailing Address - Fax:
Practice Address - Street 1:254 E HIGHWAY 246
Practice Address - Street 2:SUITE C
Practice Address - City:BUELLTON
Practice Address - State:CA
Practice Address - Zip Code:93427-9653
Practice Address - Country:US
Practice Address - Phone:805-895-1164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11733171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist