Healthcare Provider Details

I. General information

NPI: 1366044836
Provider Name (Legal Business Name): STELWIN MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 F B MERRICK CIR
RANDOLPH MA
02368-2477
US

IV. Provider business mailing address

19 F B MERRICK CIR
RANDOLPH MA
02368-2477
US

V. Phone/Fax

Practice location:
  • Phone: 617-943-5606
  • Fax:
Mailing address:
  • Phone: 617-943-5606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTIANA EGWIM
Title or Position: PRESIDENT
Credential: FNP
Phone: 617-943-5606