Individual
CAROLYN ANN WALLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
103 GARLAND ST, EVERETT, MA 02149-5066
(617) 797-4267
Mailing address
103 GARLAND ST, EVERETT, MA 02149-5066
(617) 797-4267
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
164236
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110076801A
—
MA
01
—
500030719
MEDICARE RAIL ROAD
MA
01
—
S72844
UPIN
MA
01
—
WANP1602
BCBS
MA
Enumeration date
04/02/2007
Last updated
02/10/2012
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