Provider Demographics
NPI:1295907400
Name:STROMBERG, NAN D (APRN, BC)
Entity type:Individual
Prefix:MS
First Name:NAN
Middle Name:D
Last Name:STROMBERG
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1093 BEACON ST
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5695
Mailing Address - Country:US
Mailing Address - Phone:617-731-4575
Mailing Address - Fax:
Practice Address - Street 1:1093 BEACON ST
Practice Address - Street 2:SUITE 3C
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5695
Practice Address - Country:US
Practice Address - Phone:617-731-4575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA130834364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult