Provider Demographics
NPI:1912935404
Name:STRINDBERG, MARYANNE (APRN)
Entity type:Individual
Prefix:
First Name:MARYANNE
Middle Name:
Last Name:STRINDBERG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 HOPMEADOW ST
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-2415
Mailing Address - Country:US
Mailing Address - Phone:860-408-4882
Mailing Address - Fax:
Practice Address - Street 1:558 HOPMEADOW ST
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-2415
Practice Address - Country:US
Practice Address - Phone:860-408-4882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTMS0501812363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
400002243CT02OtherBCBS
P00304847OtherPALMETTO GBA
500001565Medicare ID - Type Unspecified
P00304847OtherPALMETTO GBA