Healthcare Provider Details

I. General information

NPI: 1023032166
Provider Name (Legal Business Name): NINA E. PINGER APRN,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 MYSTIC AVE STE 6 DCS MENTAL HEALTH
MEDFORD MA
02155-4632
US

IV. Provider business mailing address

PO BOX 189
GOSHEN MA
01032-0189
US

V. Phone/Fax

Practice location:
  • Phone: 781-396-1199
  • Fax:
Mailing address:
  • Phone: 413-268-3655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number155102
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: