Healthcare Provider Details

I. General information

NPI: 1083151260
Provider Name (Legal Business Name): CHERIE WILDRICK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 WASHINGTON ST STE 203
DEDHAM MA
02026-6717
US

IV. Provider business mailing address

16 BILLYS LN
EAST FREETOWN MA
02717-1031
US

V. Phone/Fax

Practice location:
  • Phone: 781-404-7045
  • Fax: 781-326-1384
Mailing address:
  • Phone: 774-488-1719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN2282943
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN2282943
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: