Provider Demographics
NPI:1255107710
Name:NANTABA, ELIZABETH RUTH (DNP)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:RUTH
Last Name:NANTABA
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BUCKHILL RD
Mailing Address - Street 2:
Mailing Address - City:TYNGSBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01879-1286
Mailing Address - Country:US
Mailing Address - Phone:781-964-9651
Mailing Address - Fax:
Practice Address - Street 1:12 BUCKHILL RD
Practice Address - Street 2:
Practice Address - City:TYNGSBORO
Practice Address - State:MA
Practice Address - Zip Code:01879-1286
Practice Address - Country:US
Practice Address - Phone:781-964-9651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2311178163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse