Individual
WIBIE S ALTIDOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
40 HERROD AVE UNIT 1, BROCKTON, MA 02301-2359
(781) 883-6172
Mailing address
40 HERROD AVE UNIT 1, BROCKTON, MA 02301-2359
(781) 883-6172
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN10008490
MA
164W00000X
Licensed Practical Nurse
LN9400
MA
Other
Enumeration date
10/26/2017
Last updated
05/21/2026
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