Individual
KIM ELLEN WALECKA I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
228 OLD WESTPORT RD, DARTMOUTH, MA 02747-2353
(774) 202-5729
Mailing address
228 OLD WESTPORT RD, DARTMOUTH, MA 02747-2353
(774) 202-5729
(508) 648-1571
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
216893
MA
Other
Enumeration date
12/19/2005
Last updated
10/12/2011
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