Organization
WOLVERINE HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ETHAN SLABAUGH DNP, FNP-BC, BSN, RN (NURSE PRACTITIONER)
(617) 517-6340
Entity
Organization
Contact information
Practice address
82 WENDELL AVE STE 100, PITTSFIELD, MA 01201-7066
(617) 517-6340
(423) 301-6604
Mailing address
82 WENDELL AVE STE 100, PITTSFIELD, MA 01201-7066
(617) 517-6340
(423) 301-6604
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
02/15/2025
Last updated
02/19/2025
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