Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 55679 | MA |
NPI | 1104880483 |
---|---|
Provider Name | Lucette Nadle |
First Address | Westborough, MA 01581-1758 |
Second Address | Westborough, MA 01581-1758 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 01/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
722313 | TUFTS HEALTH PLAN (01) | MA |
9731041 | (05) | MA |
AA6781 | HARVARD PILGRIM HEALTHCAR (01) | MA |
D87881 | (02) | |
J08035 | BLUE CROSS/BLUE SHIELD (01) | MA |