NPIMap

Organization Active NPI

Elyse Provencher LLC

  • Acupuncturist
  • Annapolis, MD
National Provider Identifier
1356607428
Registry record updated Apr 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
AcupuncturistTaxonomy code 171100000X
Legal business name
ELYSE PROVENCHER LLC
Practice address
2009 Tidewater Colony Dr
Suite B2
Annapolis, MD 21401-2107
Phone
(410) 573-1938
NPI assigned
Apr 3, 2012
Last updated
Apr 3, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Elyse Provencher, L.AC.NPI 1568673192
Title
President
Phone
(410) 573-1938

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X NU Primary

Addresses

Primary practice location

2009 Tidewater Colony Dr
Suite B2
Annapolis, MD 21401-2107

Mailing address

2009 Tidewater Colony Dr
Suite B2
Annapolis, MD 21401-2107
Phone (410) 573-1938

National Provider Directory

National Provider Directory

Locations

2009 Tidewater Colony Dr
Ste B2
Annapolis, MD 21401
Phone (410) 271-3935

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1333411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333411200000",
    "number": "1356607428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2009 TIDEWATER COLONY DR",
            "address_2": "SUITE B2",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214012107",
            "telephone_number": "410-573-1938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2009 TIDEWATER COLONY DR",
            "address_2": "SUITE B2",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214012107",
            "telephone_number": "410-573-1938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELYSE PROVENCHER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-03",
        "last_updated": "2012-04-03",
        "status": "A",
        "authorized_official_last_name": "PROVENCHER",
        "authorized_official_first_name": "ELYSE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-573-1938",
        "authorized_official_credential": "L.AC."
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Annapolis, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.