Provider Demographics
NPI:1275936353
Name:STREET, NANCY WHITE (SCD, PPCNP, BC)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:WHITE
Last Name:STREET
Suffix:
Gender:F
Credentials:SCD, PPCNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-2118
Mailing Address - Country:US
Mailing Address - Phone:617-699-8099
Mailing Address - Fax:
Practice Address - Street 1:235 WELLESLEY ST
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-1545
Practice Address - Country:US
Practice Address - Phone:781-768-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN152087363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics