Provider Demographics
NPI:1982983292
Name:AZENSTEIN, ELEONORA (NP)
Entity Type:Individual
Prefix:MS
First Name:ELEONORA
Middle Name:
Last Name:AZENSTEIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 WALNUT ST STE 330
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2154
Mailing Address - Country:US
Mailing Address - Phone:617-630-0380
Mailing Address - Fax:
Practice Address - Street 1:65 WALNUT ST STE 330
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2154
Practice Address - Country:US
Practice Address - Phone:617-875-9325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2264132363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily