Provider Demographics
NPI:1952777823
Name:CRESCENZI, GUINEVERE GROGAN (LAC, MOM)
Entity type:Individual
Prefix:
First Name:GUINEVERE
Middle Name:GROGAN
Last Name:CRESCENZI
Suffix:
Gender:F
Credentials:LAC, MOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3130
Mailing Address - Country:US
Mailing Address - Phone:717-413-5476
Mailing Address - Fax:
Practice Address - Street 1:2215 DUTCH GOLD DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-1940
Practice Address - Country:US
Practice Address - Phone:717-413-5476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-14
Last Update Date:2024-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001074171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist