| Doctor Name: | MRS. KRISTINE K WAILGUM |
| NPI Number: | 1477524031 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 110009 |
| Business Practice Address: | 770 Converse St Longmeadow, MA - 011061719 |
| Business Phone Number: | 4135673949 |
| Business Fax Number: | 4135670175 |
| Mailing Address: | Po Box 789, LUDLOW |
| State: | MA |
| Postal Code: | 010560789 |
| Phone Number: | 4135091000 |
| Fax Number: | 4135091003 |
| NPI Enumeration Date: | 01/31/2006 |
| NPI Last Update Date: | 10/25/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 110009 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |