Provider Demographics
NPI:1790724912
Name:WOLANSKI, ANDREW P (NP)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:P
Last Name:WOLANSKI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16 TREMONT STREET
Mailing Address - Street 2:#1
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150
Mailing Address - Country:US
Mailing Address - Phone:617-632-6623
Mailing Address - Fax:617-632-2630
Practice Address - Street 1:44 BINNEY STREET
Practice Address - Street 2:SW460
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-632-6623
Practice Address - Fax:617-632-2630
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA215647163WP2201X
MA215647NP363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWO NP3517Medicare ID - Type UnspecifiedMEDICARE B PROVIDER#