Provider Demographics
NPI:1306079074
Name:LANCE, HEATHER JAMIESON (LIC AC)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:JAMIESON
Last Name:LANCE
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 MORTON AVE
Mailing Address - Street 2:APT. 1
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-6436
Mailing Address - Country:US
Mailing Address - Phone:617-599-3524
Mailing Address - Fax:
Practice Address - Street 1:84 MORTON AVE
Practice Address - Street 2:APT. 1
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-6436
Practice Address - Country:US
Practice Address - Phone:617-599-3524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233905171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist