Provider Demographics
NPI:1104637487
Name:ORDAKOWSKI, DYAN MARIE (LAC)
Entity type:Individual
Prefix:
First Name:DYAN
Middle Name:MARIE
Last Name:ORDAKOWSKI
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 1:506 OELLA AVE
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4724
Mailing Address - Country:US
Mailing Address - Phone:443-857-3866
Mailing Address - Fax:
Practice Address - Street 1:1603 EDMONDSON AVE FL 2
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4960
Practice Address - Country:US
Practice Address - Phone:443-857-3866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU03179171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist