Provider Demographics
NPI:1740740737
Name:WESTERN NEW ENGLAND UNIVERSITY
Entity Type:Organization
Organization Name:WESTERN NEW ENGLAND UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE AND ADMIN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:413-782-1219
Mailing Address - Street 1:215 WILBRAHAM ROAD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01119
Mailing Address - Country:US
Mailing Address - Phone:413-782-1211
Mailing Address - Fax:413-796-2255
Practice Address - Street 1:215 WILBRAHAM ROAD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01119
Practice Address - Country:US
Practice Address - Phone:413-782-1211
Practice Address - Fax:413-796-2255
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN NEW ENGLAND UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty