Provider Demographics
NPI:1417103193
Name:D'ANGELO, LOREN JEAN (CPNP)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:JEAN
Last Name:D'ANGELO
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE -
Mailing Address - Street 2:CHILDREN'S HOSPITAL BOSTON FEGAN 707
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02113
Mailing Address - Country:US
Mailing Address - Phone:617-355-3434
Mailing Address - Fax:617-730-0641
Practice Address - Street 1:300 LONGWOOD AVE -
Practice Address - Street 2:CHILDREN'S HOSPITAL BOSTON FEGAN 707
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02113
Practice Address - Country:US
Practice Address - Phone:617-355-3434
Practice Address - Fax:617-730-0641
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003835363LP0200X
MARN246327363LP0808X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health