Provider Demographics
NPI:1649537705
Name:VESTAL, NATALIE ELAINE (MAOM, LIS AC)
Entity type:Individual
Prefix:MISS
First Name:NATALIE
Middle Name:ELAINE
Last Name:VESTAL
Suffix:
Gender:F
Credentials:MAOM, LIS AC
Other - Prefix:MISS
Other - First Name:NATALIE
Other - Middle Name:ELAINE
Other - Last Name:HAZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAOM, LIS AC
Mailing Address - Street 1:106 MILFORD ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6953
Mailing Address - Country:US
Mailing Address - Phone:443-614-7534
Mailing Address - Fax:
Practice Address - Street 1:106 MILFORD ST
Practice Address - Street 2:SUITE 402
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6953
Practice Address - Country:US
Practice Address - Phone:443-614-7534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01965171100000X
MDAU01965171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist