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General NPI Number Information
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NPI Number | 1861267445
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Entity Type | Individual
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Provider Name | PETER WAINAINA NP
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Gender | Male
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Dates
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Enumeration Date | 11/23/2023
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Last Update Date | 11/23/2023
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Provider Practice Location Address
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Address Line | 95 WASHINGTON ST STE 104177
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City | CANTON
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State | MA
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Zip | 02021-4006
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Country | US
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Telephone | 781-366-0310
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Fax |
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Provider Business Mailing Address
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Address Line | 392 HIGHLAND ST
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City | STOUGHTON
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State | MA
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Zip | 02072-3878
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Country | US
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Telephone | 781-424-9962
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN279463
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License Number State | MA
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