Provider Demographics
NPI:1124463856
Name:PRESCOTT, ELOISE LORRAINE (MAC, LAC)
Entity type:Individual
Prefix:
First Name:ELOISE
Middle Name:LORRAINE
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E PLUMSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-1255
Mailing Address - Country:US
Mailing Address - Phone:267-240-5109
Mailing Address - Fax:
Practice Address - Street 1:315 S 13TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5917
Practice Address - Country:US
Practice Address - Phone:267-240-5109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000978171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist