Provider Demographics
NPI:1780737890
Name:GIALLOMBARDO, NANCY (NP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:GIALLOMBARDO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19 WINCHESTER ST
Mailing Address - Street 2:# 301
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2738
Mailing Address - Country:US
Mailing Address - Phone:617-667-1756
Mailing Address - Fax:617-667-3305
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:KS-121
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-1756
Practice Address - Fax:617-667-3305
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA172398363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0701874Medicaid
MA0701874Medicaid