Provider Demographics
NPI:1750835377
Name:SUNDBORG, ELIZABETH KASNY (FNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KASNY
Last Name:SUNDBORG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:KASNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 RIVERSIDE ST UNIT 6B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1073
Mailing Address - Country:US
Mailing Address - Phone:207-661-2000
Mailing Address - Fax:207-661-2033
Practice Address - Street 1:1 HARNOIS AVE STE 2A
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4395
Practice Address - Country:US
Practice Address - Phone:207-661-3400
Practice Address - Fax:207-661-3401
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN55933163W00000X
MECNP161061207RP1001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease