Provider Demographics
NPI:1659620623
Name:WEFALD, PATRICIA MARIA (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIA
Last Name:WEFALD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:CALLAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 GROSSMAN DR.
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184
Mailing Address - Country:US
Mailing Address - Phone:781-849-2400
Mailing Address - Fax:781-849-2593
Practice Address - Street 1:111 GROSSMAN DR.
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184
Practice Address - Country:US
Practice Address - Phone:781-849-2400
Practice Address - Fax:781-849-2593
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2264061363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health