Provider Demographics
NPI:1952102659
Name:NAKAMATTE SUBER, JOAN
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:NAKAMATTE SUBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ELLIOT ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1604
Mailing Address - Country:US
Mailing Address - Phone:978-942-9894
Mailing Address - Fax:
Practice Address - Street 1:25 ELLIOT ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02461-1604
Practice Address - Country:US
Practice Address - Phone:978-942-9894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN10019676163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty