Healthcare Provider Details

I. General information

NPI: 1134311731
Provider Name (Legal Business Name): JANE A ANGSTROM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

400 W CUMMINGS PARK SUITE 2250
WOBURN MA
01801-6519
US

IV. Provider business mailing address

13 BROAD ST
DANVERS MA
01923-3709
US

V. Phone/Fax

Practice location:
  • Phone: 800-833-1220
  • Fax: 866-932-1118
Mailing address:
  • Phone: 978-774-5783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD1100X
TaxonomyPeritoneal Dialysis Registered Nurse
License Number81735
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: