Individual
MS. MARY ANN WENNERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
800 WASHINGTON ST, BOX 268, BOSTON, MA 02111-1552
(617) 636-5691
(617) 636-8187
Mailing address
33 POND AVE APT T33, BROOKLINE, MA 02445-7163
(617) 566-1508
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
000775701
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110081398A
—
MA
01
—
RN106245
MA LICENSE NUMBER
MA
Enumeration date
05/16/2007
Last updated
03/31/2016
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