Healthcare Provider Details

I. General information

NPI: 1104481266
Provider Name (Legal Business Name): GEORGINA TUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GEORGINA ANYINKENG TUNG

II. Dates (important events)

Enumeration Date: 05/04/2019
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 EDGEWATER PL STE 100
WAKEFIELD MA
01880-1281
US

IV. Provider business mailing address

207 CONNORS ST
FITCHBURG MA
01420-7263
US

V. Phone/Fax

Practice location:
  • Phone: 781-922-6363
  • Fax:
Mailing address:
  • Phone: 781-521-8814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2323510
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: