Healthcare Provider Details

I. General information

NPI: 1215001540
Provider Name (Legal Business Name): ANN L WISSINK RNCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MOUNT AUBURN ST CLARK 1
CAMBRIDGE MA
02138-5502
US

IV. Provider business mailing address

ONE ARSENAL MARKETPLACE
WATERTOWN MA
02472
US

V. Phone/Fax

Practice location:
  • Phone: 617-499-5054
  • Fax: 617-499-5465
Mailing address:
  • Phone: 617-673-1851
  • Fax: 617-499-5579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number117810
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: