Provider Demographics
NPI:1447483425
Name:GIRARD, VANNESZA EUNICE (LAC)
Entity type:Individual
Prefix:
First Name:VANNESZA
Middle Name:EUNICE
Last Name:GIRARD
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 1:94322 BERRY RD
Mailing Address - Street 2:
Mailing Address - City:GOLD BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97444-7728
Mailing Address - Country:US
Mailing Address - Phone:805-680-3876
Mailing Address - Fax:
Practice Address - Street 1:29692 ELLENSBURG AVE
Practice Address - Street 2:
Practice Address - City:GOLD BEACH
Practice Address - State:OR
Practice Address - Zip Code:97444-8701
Practice Address - Country:US
Practice Address - Phone:541-247-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01293171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist