Provider Demographics
NPI:1952752545
Name:CARSTENS, MARY LYNN (LAC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:LYNN
Last Name:CARSTENS
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 1:601 BRADY ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-5267
Mailing Address - Country:US
Mailing Address - Phone:563-650-6747
Mailing Address - Fax:
Practice Address - Street 1:601 BRADY ST
Practice Address - Street 2:SUITE 304
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-5267
Practice Address - Country:US
Practice Address - Phone:563-650-6747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-25
Last Update Date:2016-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-43171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA-43OtherACUPUNCTURE