Provider Demographics
NPI:1255830543
Name:ALWENY, PEARL (NP)
Entity Type:Individual
Prefix:
First Name:PEARL
Middle Name:
Last Name:ALWENY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PENNINAH
Other - Middle Name:GLADYS
Other - Last Name:ALWENY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 541378
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02454-1378
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:273 RIDGE LN APT 308
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-4990
Practice Address - Country:US
Practice Address - Phone:857-316-8020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN22828832084P0800X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA78188Medicaid