Wisteria Health LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

WISTERIA HEALTH LLC

Practice address

82 Wendell Ave Ste 100
Pittsfield, MA 01201-7066

Phone

(617) 903-7770

NPI assigned

Apr 18, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ethan Slabaugh

Title

Nurse Practitioner

Phone

(617) 903-7770

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1713398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713398400000",
    "number": "1649025123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "82 WENDELL AVE STE 100",
            "city": "PITTSFIELD",
            "state": "MA",
            "postal_code": "012017066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 WENDELL AVE STE 100",
            "city": "PITTSFIELD",
            "state": "MA",
            "postal_code": "012017066",
            "telephone_number": "617-903-7770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISTERIA HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-18",
        "last_updated": "2024-04-18",
        "certification_date": "2024-04-15",
        "status": "A",
        "authorized_official_last_name": "SLABAUGH",
        "authorized_official_first_name": "ETHAN",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "617-903-7770"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Wilson, M.A.
• David Whiting Wilson, M.D.
• Kathleen Wilson
• Logan Wilson, DMD
• Taya Win, MS
• Katy Wixsom
• Ashley Wnuk
• Charles I Wohl, MD FACP
• Jennifer M Wojtkowski, R.D., L.D.N.
• Michaelene Wojtkowski

• Community/Behavioral Health Agency in Pittsfield, MA
• Providers in Pittsfield, MA by specialty
• Community/Behavioral Health Agency in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.