Provider Demographics
NPI:1508096801
Name:NOLTE, ELIZABETH DIANE (LAC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DIANE
Last Name:NOLTE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:DIANE
Other - Last Name:HUDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:2775 FRIENDLY ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405
Mailing Address - Country:US
Mailing Address - Phone:541-683-0886
Mailing Address - Fax:
Practice Address - Street 1:2775 FRIENDLY ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405
Practice Address - Country:US
Practice Address - Phone:541-683-0886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00911171100000X
ORAC00911171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist