Provider Demographics
NPI:1225790801
Name:HULTIN, ELSA ANNIKA ELISABET (LAC)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:ANNIKA ELISABET
Last Name:HULTIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 GREAT RD APT C2
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-4053
Mailing Address - Country:US
Mailing Address - Phone:775-233-1039
Mailing Address - Fax:
Practice Address - Street 1:9 CORNERSTONE SQ # 9H
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-1473
Practice Address - Country:US
Practice Address - Phone:978-577-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist