Healthcare Provider Details

I. General information

NPI: 1023650660
Provider Name (Legal Business Name): WOUDELYNE JEAN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 SUMNER ST
STOUGHTON MA
02072-3396
US

IV. Provider business mailing address

56 GALEN ST
BROCKTON MA
02302-3336
US

V. Phone/Fax

Practice location:
  • Phone: 781-297-8200
  • Fax:
Mailing address:
  • Phone: 774-274-2563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN284634
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: