Healthcare Provider Details

I. General information

NPI: 1487160206
Provider Name (Legal Business Name): BRIANA KAREN DEWOLFE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANA KAREN WISE

II. Dates (important events)

Enumeration Date: 12/15/2017
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2696
US

IV. Provider business mailing address

PO BOX 415348
BOSTON MA
02241-5348
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-2000
  • Fax:
Mailing address:
  • Phone: 800-225-8885
  • Fax: 508-334-8105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2304116
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: