Provider Demographics
NPI:1780984054
Name:NORBERG, MANDY CARIN (RN)
Entity type:Individual
Prefix:MISS
First Name:MANDY
Middle Name:CARIN
Last Name:NORBERG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19046 ODELL RD
Mailing Address - Street 2:
Mailing Address - City:FRAZEYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43822-9551
Mailing Address - Country:US
Mailing Address - Phone:740-828-2290
Mailing Address - Fax:
Practice Address - Street 1:19046 ODELL RD
Practice Address - Street 2:
Practice Address - City:FRAZEYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43822-9551
Practice Address - Country:US
Practice Address - Phone:740-828-2290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH314799163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse