Healthcare Provider Details

I. General information

NPI: 1376230391
Provider Name (Legal Business Name): PATHWAY TO BETTER HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 02/25/2024
Certification Date: 02/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 CENTRAL ST STE 303
LOWELL MA
01852-1931
US

IV. Provider business mailing address

97 CENTRAL ST STE 303
LOWELL MA
01852-1931
US

V. Phone/Fax

Practice location:
  • Phone: 978-487-6783
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JESSICA WISOCKY
Title or Position: MANAGER
Credential: FNP
Phone: 978-487-6783