MEDICARE: MR. WESLEY IRISH FNP

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	0000000089250744	RI

General Provider Information

NPI Number	:	1962970947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WESLEY IRISH FNP

Provider Business Mailing Address
First Line	:	21 PEKIN ST
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02908-3716
Country	:	US
Telephone Number	:	401-527-0615
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 PEKIN ST
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02908-3716
Country	:	US
Telephone Number	:	401-527-0615
Fax Number	:

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

Provider Enumeration Date	:	11/07/2018
Last Update Date	:	11/07/2018

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