Provider Demographics
NPI:1881636520
Name:ANSON-WONKKA, CECILIA M (MSRNCS)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:M
Last Name:ANSON-WONKKA
Suffix:
Gender:F
Credentials:MSRNCS
Other - Prefix:
Other - First Name:CECILIA
Other - Middle Name:M
Other - Last Name:ANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSRNCS
Mailing Address - Street 1:319 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-3968
Mailing Address - Country:US
Mailing Address - Phone:413-540-1155
Mailing Address - Fax:
Practice Address - Street 1:575 BEECH STREET
Practice Address - Street 2:HOLYOKE MEDICAL CENTER
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040
Practice Address - Country:US
Practice Address - Phone:413-534-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA175589364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS99735Medicare UPIN
MANS0341Medicare ID - Type Unspecified