Individual
LORRAINE WILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
940 BELMONT ST, BROCKTON, MA 02301-5596
(774) 826-1285
Mailing address
103 MYRON ST STE A, WEST SPRINGFIELD, MA 01089-1485
(413) 592-1980
(413) 439-0100
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
PENDING
MA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN2260362
MA
Other
Enumeration date
07/18/2017
Last updated
07/21/2022
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