Provider Demographics
NPI:1487160206
Name:DEWOLFE, BRIANA KAREN (CNP)
Entity type:Individual
Prefix:MS
First Name:BRIANA
Middle Name:KAREN
Last Name:DEWOLFE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:BRIANA
Other - Middle Name:KAREN
Other - Last Name:WISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-8105
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:508-334-7917
Practice Address - Fax:508-856-5074
Is Sole Proprietor?:No
Enumeration Date:2017-12-15
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2304116363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner