Individual
KIERNAN PATRICK WYLLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 334-3271
(508) 856-5911
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN2313455
MA
367500000X
Certified Registered Nurse Anesthetist
Primary
RN2313455
MA
Other
Enumeration date
06/18/2021
Last updated
08/15/2022
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