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General NPI Number Information
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NPI Number | 1457183329
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Entity Type | Organization
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Legal Business Name | PRIMARY CHOICE
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Dates
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Enumeration Date | 08/19/2024
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 255 PARK AVE
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City | WORCESTER
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State | MA
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Zip | 01609-1953
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Country | US
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Telephone | 508-873-8204
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Fax |
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Provider Business Mailing Address
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Address Line | 255 PARK AVE STE 705
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City | WORCESTER
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State | MA
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Zip | 01609-1929
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Country | US
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Telephone | 508-459-0043
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Fax | 508-459-0043
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Authorized Official
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Title or Position | OWNER
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Name | ALEKSANDRA ALWASH
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Credential | NP
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Telephone | 508-459-0043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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