Provider Demographics
NPI:1275089575
Name:NANCY LANDRY PLLC
Entity Type:Organization
Organization Name:NANCY LANDRY PLLC
Other - Org Name:SOMERVILLE FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:617-628-2160
Mailing Address - Street 1:SOMERVILLE FAMILY PRACTICE
Mailing Address - Street 2:1020 BROADWAY
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144
Mailing Address - Country:US
Mailing Address - Phone:617-628-2160
Mailing Address - Fax:617-628-8237
Practice Address - Street 1:SOMERVILLE FAMILY PRACTICE
Practice Address - Street 2:1020 BROADWAY
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144
Practice Address - Country:US
Practice Address - Phone:617-628-2160
Practice Address - Fax:617-628-8237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty