Provider Demographics
NPI:1376166801
Name:NASSTROM, BLAIRE ELISE (DO, MPH)
Entity Type:Individual
Prefix:
First Name:BLAIRE
Middle Name:ELISE
Last Name:NASSTROM
Suffix:
Gender:F
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 SANSOM ST APT 302
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5180
Mailing Address - Country:US
Mailing Address - Phone:925-588-8559
Mailing Address - Fax:
Practice Address - Street 1:3 COOPER PLZ RM 221
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:925-588-8559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program