Healthcare Provider Details

I. General information

NPI: 1104880483
Provider Name (Legal Business Name): LUCETTE NADLE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E MAIN ST STE 1E
WESTBOROUGH MA
01581-1758
US

IV. Provider business mailing address

160 E MAIN ST STE 1E
WESTBOROUGH MA
01581-1758
US

V. Phone/Fax

Practice location:
  • Phone: 508-366-9686
  • Fax: 508-366-9435
Mailing address:
  • Phone: 508-366-9686
  • Fax: 508-366-9435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number55679
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: