Individual
MS. STEPHANIE C WIAFE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655
(508) 334-3452
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
204685
MA
363LA2100X
Acute Care Nurse Practitioner
Primary
RN204685
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0798819
—
MA
05
—
110025351A
—
MA
Enumeration date
03/10/2006
Last updated
03/21/2022
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