Provider Demographics
NPI:1902066657
Name:RECTANUS, ELIZABETH R (LIC AC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:RECTANUS
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 1:384 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1717
Mailing Address - Country:US
Mailing Address - Phone:617-714-5433
Mailing Address - Fax:
Practice Address - Street 1:384 BROADWAY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1717
Practice Address - Country:US
Practice Address - Phone:617-714-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209187171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist