Provider Demographics
NPI:1477177335
Name:WYVEKENS, NICOLAS (MD)
Entity Type:Individual
Prefix:MR
First Name:NICOLAS
Middle Name:
Last Name:WYVEKENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FRANCIS STREET DEPARTMENT OF PATHOLOGY, BRIGHAM AND
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS STREET DEPARTMENT OF PATHOLOGY, BRIGHAM AND
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-732-7510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2022-02-17
Deactivation Date:2022-01-18
Deactivation Code:
Reactivation Date:2022-02-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program