Individual
MRS. KRISTINE K WAILGUM
Active
Individual
MRS. KRISTINE K WAILGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
110009
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0710296
—
MA
01
—
8303930
EVERCARE
MA
01
—
NP2697
BLUE CROSS
MA
Enumeration date
01/31/2006
Last updated
10/25/2011
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