Individual
MRS. KRISTINE K WAILGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
770 CONVERSE ST, LONGMEADOW, MA 01106-1719
(413) 567-3949
(413) 567-0175
Mailing address
PO BOX 789, LUDLOW, MA 01056-0789
(413) 509-1000
(413) 509-1003
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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