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General NPI Number Information
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NPI Number | 1417576554
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Entity Type | Individual
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Provider Name | MARK WAKSMONSKI APRN
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Gender | Male
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Dates
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Enumeration Date | 04/09/2020
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Last Update Date | 04/09/2020
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Provider Practice Location Address
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Address Line | 12 MUDGE WAY
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City | BEDFORD
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State | MA
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Zip | 01730-2147
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Country | US
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Telephone | 781-275-6507
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 659
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City | LONDONDERRY
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State | NH
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Zip | 03053-0659
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Country | US
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Telephone |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN2282430
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License Number State | MA
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