Provider Demographics
NPI:1083151260
Name:WILDRICK, CHERIE (NP)
Entity Type:Individual
Prefix:
First Name:CHERIE
Middle Name:
Last Name:WILDRICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BILLYS LN
Mailing Address - Street 2:
Mailing Address - City:EAST FREETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02717-1031
Mailing Address - Country:US
Mailing Address - Phone:774-488-1719
Mailing Address - Fax:
Practice Address - Street 1:990 WASHINGTON ST STE 203
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-6717
Practice Address - Country:US
Practice Address - Phone:781-404-7045
Practice Address - Fax:781-326-1384
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2282943163WG0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice