Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | F11180808 | MA |
NPI | 1013481290 |
---|---|
Provider Name | Ms. Jenna Lee Wessels |
First Address | Somerville, MA 02143-1305 |
Second Address | Waltham, MA 02453-2761 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2019 |
Last Update Date | 21/01/2019 |