Provider Demographics
NPI:1063151660
Name:NORSTROM, DENISE MICHELLE (RN)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:MICHELLE
Last Name:NORSTROM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 STATE HIGHWAY 37
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:NY
Mailing Address - Zip Code:13646-3282
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:799 STATE HIGHWAY 37
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:NY
Practice Address - Zip Code:13646-3282
Practice Address - Country:US
Practice Address - Phone:315-222-8398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY644723163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse