MEDICARE: MRS. TAMIKA YVETTE WISDOM NURSE PRACTITIONER

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	363LF0000X	Family Nurse Practitioner	RN2313970	MA

General Provider Information

NPI Number	:	1275887101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMIKA YVETTE WISDOM NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	637 WASHINGTON ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02124-3510
Country	:	US
Telephone Number	:	617-825-9660
Fax Number	:

Provider Business Practice Location Address
First Line	:	637 WASHINGTON ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02124-3510
Country	:	US
Telephone Number	:	617-825-9660
Fax Number	:

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

Provider Enumeration Date	:	10/30/2012
Last Update Date	:	05/01/2024

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