Provider Demographics
NPI:1265617922
Name:NASTROLIA, DENISE LYNN (CPM, LM)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:LYNN
Last Name:NASTROLIA
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:MRS
Other - First Name:DENISE
Other - Middle Name:LYNN
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPM, LM
Mailing Address - Street 1:2201 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-6006
Mailing Address - Country:US
Mailing Address - Phone:903-566-6919
Mailing Address - Fax:903-566-6919
Practice Address - Street 1:2201 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-6006
Practice Address - Country:US
Practice Address - Phone:903-566-6919
Practice Address - Fax:903-566-6919
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05005175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay