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General NPI Number Information
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NPI Number | 1114381407
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Entity Type | Organization
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Legal Business Name | CHRISTIAN SCIENCE PROVIDER NETWORK
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Dates
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Enumeration Date | 04/12/2016
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Last Update Date | 04/12/2016
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Provider Practice Location Address
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Address Line | 18 MAIN STREET EXT SUITE 402
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City | PLYMOUTH
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State | MA
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Zip | 02360-3384
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Country | US
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Telephone | 617-510-6491
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Fax |
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Provider Business Mailing Address
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Address Line | 18 MAIN STREET EXT SUITE 402
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City | PLYMOUTH
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State | MA
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Zip | 02360-3384
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Country | US
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Telephone | 617-510-6491
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | WANDA JANE WARMACK
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Credential |
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Telephone | 617-510-6491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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