Provider Demographics
NPI:1083781710
Name:LUSTGARTEN, NANCY A (LIC AC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:LUSTGARTEN
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WARD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2821
Mailing Address - Country:US
Mailing Address - Phone:413-530-9945
Mailing Address - Fax:
Practice Address - Street 1:16 CENTER ST
Practice Address - Street 2:SUITE 518
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3031
Practice Address - Country:US
Practice Address - Phone:413-530-9945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208023171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist