MEDICARE: KIRA WOLLENSAK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN2380561	MA

General Provider Information

NPI Number	:	1033040670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRA WOLLENSAK

Provider Business Mailing Address
First Line	:	147 MASON TER APT 1
Second Line	:
City	:	BROOKLINE
State	:	MA
Zip	:	02446-2781
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	147 MASON TER
Second Line	:
City	:	BROOKLINE
State	:	MA
Zip	:	02446-2781
Country	:	US
Telephone Number	:	802-595-5144
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2026
Last Update Date	:	05/25/2026

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Directions to “ KIRA WOLLENSAK ” Practice Location

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