Provider Demographics
NPI:1952842080
Name:NGUYEN, ELISE
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PARKER ST
Mailing Address - Street 2:APT 2
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3912
Mailing Address - Country:US
Mailing Address - Phone:603-305-4318
Mailing Address - Fax:
Practice Address - Street 1:11 PARKER ST
Practice Address - Street 2:APT 2
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-3912
Practice Address - Country:US
Practice Address - Phone:603-305-4318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist