Healthcare Provider Details

I. General information

NPI: 1790724912
Provider Name (Legal Business Name): ANDREW P. WOLANSKI NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 BINNEY STREET SW460
BOSTON MA
02115
US

IV. Provider business mailing address

16 TREMONT STREET #1
CHELSEA MA
02150
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-6623
  • Fax: 617-632-2630
Mailing address:
  • Phone: 617-632-6623
  • Fax: 617-632-2630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number215647
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number215647NP
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number215647NP
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: