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General NPI Number Information
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NPI Number | 1932900396
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Entity Type | Individual
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Provider Name | ILAN MILLSTROM RN
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Gender |
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Dates
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Enumeration Date | 03/21/2025
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 2 CONSTITUTION PLZ
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City | CHARLESTOWN
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State | MA
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Zip | 02129-2021
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Country | US
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Telephone | 617-724-9852
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 440031
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City | SOMERVILLE
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State | MA
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Zip | 02144-0001
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Country | US
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Telephone | 646-450-2495
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN2391393
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN2391393
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License Number State | MA
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