Individual
KATHERINE WENTZELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
1 JOSLIN PL, PEDIATRICS, BOSTON, MA 02215-5306
(617) 732-2603
(617) 309-2451
Mailing address
1 JOSLIN PL, PEDIATRICS, BOSTON, MA 02215-5306
(617) 732-2603
(617) 309-2451
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
284349
MA
363LP0200X
Pediatric Nurse Practitioner
Primary
RN284349
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1320858
GROUP MEDICAID NUMBER
MA
Enumeration date
08/05/2009
Last updated
01/10/2012
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