Provider Demographics
NPI:1437622370
Name:NYBERG, ANNE (MS, LCGC)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:NYBERG
Suffix:
Gender:F
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:NYBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:BOSTON MEDICAL CENTER DEPARTMENT OF PEDIATRICS
Mailing Address - Street 2:771 ALBANY ST, RM. 3509
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:617-414-7495
Mailing Address - Fax:
Practice Address - Street 1:850 HARRISON AVE FL YAWKEY6
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-4001
Practice Address - Country:US
Practice Address - Phone:617-414-7495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAGC440170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS