Individual
MICHELLE WOOLFREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
415 SOUTH ST, WALTHAM, MA 02453-2700
(781) 736-3677
Mailing address
415 SOUTH ST, WALTHAM, MA 02453-2700
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APRN00684
RI
363L00000X
Nurse Practitioner
Primary
RN2276617
MA
363LA2200X
Adult Health Nurse Practitioner
APRN00684
RI
363LA2200X
Adult Health Nurse Practitioner
RN2276617
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05-0483739
TAX ID #
RI
05
—
1922486554
—
RI
01
—
709004158
MEDICARE GROUP PTAN
RI
Enumeration date
05/15/2015
Last updated
04/24/2022
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