Healthcare Provider Details

I. General information

NPI: 1427138254
Provider Name (Legal Business Name): PETER BENJAMIN LANDSTROM APRN,BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W SILVER ST
WESTFIELD MA
01085-3628
US

IV. Provider business mailing address

PO BOX 342 26 PETTICOAT HILL ROAD
WILLIAMSBURG MA
01096-0342
US

V. Phone/Fax

Practice location:
  • Phone: 413-568-2811
  • Fax:
Mailing address:
  • Phone: 413-268-7049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number242991
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: