Provider Demographics
NPI:1700919214
Name:DOUTHWAITE, PATRICIA ANN (L AC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:DOUTHWAITE
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:MS
Other - First Name:TISHA
Other - Middle Name:
Other - Last Name:DOUTHWAITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:L AC
Mailing Address - Street 1:PO BOX 1386
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-1386
Mailing Address - Country:US
Mailing Address - Phone:707-467-0335
Mailing Address - Fax:
Practice Address - Street 1:564 S DORA ST
Practice Address - Street 2:SUITE A
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5486
Practice Address - Country:US
Practice Address - Phone:707-467-0335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2868171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist