Individual
CONSTANCE L WALL-HAAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
228 BILLERICA RD, CHELMSFORD, MA 01824-3604
(978) 250-6000
(978) 250-6335
Mailing address
147 MILK ST, PROVIDER ENROLLMENT - 9TH FLOOR, BOSTON, MA 02109-4806
(617) 559-8053
(978) 250-6335
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
126600
MA
363LP0200X
Pediatric Nurse Practitioner
Primary
126600
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0359891
—
MA
01
—
NP9996
BLUE CROSS
MA
Enumeration date
03/08/2006
Last updated
03/10/2011
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