Healthcare Provider Details

I. General information

NPI: 1235613902
Provider Name (Legal Business Name): VENDLA ESLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VENDLA GUSTAVSON RN

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 HAMPSHIRE ST
CAMBRIDGE MA
02139-1306
US

IV. Provider business mailing address

237 HAMPSHIRE ST
CAMBRIDGE MA
02139-1306
US

V. Phone/Fax

Practice location:
  • Phone: 301-674-2732
  • Fax:
Mailing address:
  • Phone: 301-674-2732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN613604
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: