Healthcare Provider Details

I. General information

NPI: 1720451743
Provider Name (Legal Business Name): EILEEN WUERTHELE C.P.N.P., P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL ROAD
OAK BLUFFS MA
02557
US

IV. Provider business mailing address

1 HOSPITAL ROAD
OAK BLUFFS MA
02557
US

V. Phone/Fax

Practice location:
  • Phone: 508-693-3732
  • Fax: 508-790-6820
Mailing address:
  • Phone: 508-693-0410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN172042
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: