Individual
REBECCA T WAKULYAKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
297 PROCTOR AVE, REVERE, MA 02151-4907
(617) 849-4756
Mailing address
297 PROCTOR AVE, REVERE, MA 02151-4907
(617) 849-4756
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN87279
MA
Other
Enumeration date
01/16/2023
Last updated
01/16/2023
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