Provider Demographics
NPI:1790041952
Name:IRWIN, VICKI LYNN (LAC)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:IRWIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:LYNN
Other - Last Name:JESSOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:155 MAIN DUNSTABLE RD STE 135
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3640
Mailing Address - Country:US
Mailing Address - Phone:603-589-9805
Mailing Address - Fax:603-417-2927
Practice Address - Street 1:155 MAIN DUNSTABLE RD STE 135
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3640
Practice Address - Country:US
Practice Address - Phone:603-589-9805
Practice Address - Fax:603-417-2927
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHACP183171100000X
NH183171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist