Healthcare Provider Details

I. General information

NPI: 1487269114
Provider Name (Legal Business Name): LISA A WENTZELL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 RESEARCH PL STE 202
N CHELMSFORD MA
01863-2439
US

IV. Provider business mailing address

6 CHENEY DR
HUDSON NH
03051-3903
US

V. Phone/Fax

Practice location:
  • Phone: 978-275-1390
  • Fax: 978-275-1394
Mailing address:
  • Phone: 603-459-8134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2293965
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRN2293965
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: