Basic Information
Provider Information | |||||||||
NPI: | 1790724912 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WOLANSKI | ||||||||
FirstName: | ANDREW | ||||||||
MiddleName: | P. | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | NP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 16 TREMONT STREET | ||||||||
Address2: | #1 | ||||||||
City: | CHELSEA | ||||||||
State: | MA | ||||||||
PostalCode: | 02150 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6176326623 | ||||||||
FaxNumber: | 6176322630 | ||||||||
Practice Location | |||||||||
Address1: | 44 BINNEY STREET | ||||||||
Address2: | SW460 | ||||||||
City: | BOSTON | ||||||||
State: | MA | ||||||||
PostalCode: | 02115 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6176326623 | ||||||||
FaxNumber: | 6176322630 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/05/2006 | ||||||||
LastUpdateDate: | 08/13/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP2201X | 215647 | MA | N |   | Nursing Service Providers | Registered Nurse | Ambulatory Care | 363LA2100X | 215647NP | MA | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LA2200X | 215647NP | MA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.