Provider Demographics
NPI:1174876981
Name:NORDSTROM, NEIL (DNP)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:
Last Name:NORDSTROM
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:DR
Other - First Name:DONALD
Other - Middle Name:NEIL
Other - Last Name:NORDSTROM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP
Mailing Address - Street 1:294 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-1838
Mailing Address - Country:US
Mailing Address - Phone:413-525-1870
Mailing Address - Fax:413-525-3883
Practice Address - Street 1:294 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-1838
Practice Address - Country:US
Practice Address - Phone:413-525-1870
Practice Address - Fax:413-525-3883
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN241808363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily