Organization
WISTERIA HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ETHAN SLABAUGH (NURSE PRACTITIONER)
(617) 903-7770
Entity
Organization
Contact information
Practice address
82 WENDELL AVE STE 100, PITTSFIELD, MA 01201-7066
(617) 903-7770
Mailing address
82 WENDELL AVE STE 100, PITTSFIELD, MA 01201-7066
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
04/18/2024
Last updated
04/18/2024
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