Individual
NANCY GANTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
133 BROOKLINE AVE, BOSTON, MA 02215-3904
(617) 421-5950
Mailing address
147 MILK ST, PROVIDER ENROLLMENT 9TH FLOOR, BOSTON, MA 02109-4806
(617) 421-2508
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
107617
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0702358
—
MA
01
—
AA14337
HARVARD PILGRIM
MA
01
—
NP2566
BLUE CROSS
MA
Enumeration date
09/27/2006
Last updated
04/13/2009
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