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General NPI Number Information
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NPI Number | 1194789644
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Entity Type | Individual
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Provider Name | PAULETTE R KIMBALL-WREN MD
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Gender | Female
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 12/23/2011
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Provider Practice Location Address
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Address Line | 10 WINTHROP ST
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City | WORCESTER
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State | MA
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Zip | 01604-4435
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Country | US
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Telephone | 508-753-3120
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Fax |
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Provider Business Mailing Address
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Address Line | 22 QUAIL RUN
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City | HOLDEN
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State | MA
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Zip | 01520-3705
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Country | US
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Telephone | 508-829-3076
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 224655
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License Number State | MA
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