Healthcare Provider Details

I. General information

NPI: 1225790801
Provider Name (Legal Business Name): ELSA ANNIKA ELISABET HULTIN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CORNERSTONE SQ # 9H
WESTFORD MA
01886-1473
US

IV. Provider business mailing address

420 GREAT RD APT C2
ACTON MA
01720-4053
US

V. Phone/Fax

Practice location:
  • Phone: 978-577-5440
  • Fax:
Mailing address:
  • Phone: 775-233-1039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: