Individual
ILAN MILLSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Credential
RN
Contact information
Practice address
2 CONSTITUTION PLZ, CHARLESTOWN, MA 02129-2021
(617) 724-9852
Mailing address
PO BOX 440031, SOMERVILLE, MA 02144-0001
(646) 450-2495
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
163W00000X
Registered Nurse
RN2391393
MA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN2391393
MA
Other
Enumeration date
03/21/2025
Last updated
03/21/2025
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