| NPI Details | |
|---|---|
| NPI | 1558682815 |
| Gender | Female |
| Enumeration Date | 06/21/2010 |
| Last Updated | 12/08/2015 |
| Entity Type | Individual |
| Active | Over 7 years ago |
| Practice Location | |
|---|---|
| 243 CHARLES ST BOSTON MA, 02114-3002, US |
|
| Phone | (320) 493-4737 |
| Fax | |
| Business Location | |
|---|---|
| 243 CHARLES ST BOSTON MA, 02114-3002, US |
|
| Phone | (320) 493-4737 |
| Fax | |
| Toxanomy | |
|---|---|
| Taxonomy Code | 207YX0905X |
| License State | Michigan |
| License Number | 5101018847 |
| Remove 1558682815 NPI Number | |
According to our database, Carissa Jane Wentland DO NPI is 1558682815, taxonomy code is 207YX0905X and license number is 5101018847, license state is located at Michigan. Carissa Jane Wentland DO physically located at 243 Charles St, Boston MA, 02114-3002. NPI Number Carissa Jane Wentland DO has the Individual type.
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1558682815 NPI number is provided on an as is basis without warranty of any kind. 1558682815 is maintained by the National Plan & Provider Enumeration System. The contents of Carissa Jane Wentland DO are for informational purposes only.
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