Individual
JOHN WAHLBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
75 COREY COLONIAL, AGAWAM, MA 01001-2747
(860) 869-3708
Mailing address
75 COREY COLONIAL, AGAWAM, MA 01001-2747
(860) 869-3708
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
110099
CT
163W00000X
Registered Nurse
Primary
RN2284924
MA
Other
Enumeration date
08/17/2016
Last updated
08/17/2016
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