Individual
ALIESHA WISDOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
18 BRENTON ST, DORCHESTER, MA 02121-4108
(508) 852-1805
(508) 853-8593
Mailing address
18 BRENTON ST, DORCHESTER, MA 02121-4108
(508) 852-1805
(508) 853-8593
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
284035
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1301071
GROUP MEDIACAID NUMBER
MA
Enumeration date
11/17/2009
Last updated
11/17/2009
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