Provider Demographics
NPI:1841487428
Name:STERN, NICOLE LYNN (LIC AC, MAC)
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:LYNN
Last Name:STERN
Suffix:
Gender:F
Credentials:LIC AC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-1600
Mailing Address - Country:US
Mailing Address - Phone:781-272-0247
Mailing Address - Fax:781-425-6021
Practice Address - Street 1:30 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-1600
Practice Address - Country:US
Practice Address - Phone:781-272-0247
Practice Address - Fax:781-425-6021
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216170171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist