Healthcare Provider Details

I. General information

NPI: 1386568285
Provider Name (Legal Business Name): JEMELEE WANG AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 COMMONWEALTH AVE
CHESTNUT HILL MA
02467-3858
US

IV. Provider business mailing address

22 SHEPARD ST APT 1
BRIGHTON MA
02135-3302
US

V. Phone/Fax

Practice location:
  • Phone: 617-552-4250
  • Fax:
Mailing address:
  • Phone: 949-887-6698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number07260040
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: