=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639393374
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRISTINE WALDRON FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2007
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | BLUE HILLS MEDICAL ASSOCIATES 340 WOOD ROAD SUITE 203
-----------------------------------------------------
City | BRAINTREE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02184
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-849-1111
-----------------------------------------------------
Fax | 781-794-2280
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | BLUE HILLS MEDICAL ASSOCIATES 340 WOOD ROAD SUITE 203
-----------------------------------------------------
City | BRAINTREE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02184
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-849-1111
-----------------------------------------------------
Fax | 781-794-2280
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 197680
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------