Healthcare Provider Details

I. General information

NPI: 1275718934
Provider Name (Legal Business Name): LUCETTE NADLE DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 12/31/2007
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: DR. LUCETTE NADLE
Title or Position: OWNER
Credential: DO
Phone: 508-366-9686