Provider Demographics
NPI:1326289414
Name:VANDERBOOM, TERESA LINDA (MS, ANP-BC)
Entity Type:Individual
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First Name:TERESA
Middle Name:LINDA
Last Name:VANDERBOOM
Suffix:
Gender:F
Credentials:MS, ANP-BC
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIANS ORGANIZATION INC.
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:GRAY 241
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-1767
Practice Address - Fax:617-726-3089
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MARN246872363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner