Provider Demographics
NPI:1306176243
Name:ERNEST, PATRICIA ANN (MAC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:ERNEST
Suffix:
Gender:F
Credentials:MAC
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:VAIDULAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MAC
Mailing Address - Street 1:26 WASHINGTON SQ APT 4
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-3382
Mailing Address - Country:US
Mailing Address - Phone:978-660-7585
Mailing Address - Fax:
Practice Address - Street 1:26 WASHINGTON SQ APT 4
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-3382
Practice Address - Country:US
Practice Address - Phone:978-660-7585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-26
Last Update Date:2009-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA234810171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist