Provider Demographics
NPI:1770767543
Name:NORDENSJO, ANNA KATARINA (MD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:KATARINA
Last Name:NORDENSJO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:863 NEILSON ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-1815
Mailing Address - Country:US
Mailing Address - Phone:510-647-8535
Mailing Address - Fax:510-647-8535
Practice Address - Street 1:2023 VALE RD
Practice Address - Street 2:#107
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3834
Practice Address - Country:US
Practice Address - Phone:510-215-9092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU0000BFDCRMedicare PIN
GUE64330Medicare UPIN