Provider Demographics
NPI:1861204745
Name:HARBOR WELLNESS, PLLC
Entity type:Organization
Organization Name:HARBOR WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICAL
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ETHIER
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:508-422-0404
Mailing Address - Street 1:6 LIBERTY SQ STE 91536
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-5800
Mailing Address - Country:US
Mailing Address - Phone:508-422-0404
Mailing Address - Fax:508-422-0404
Practice Address - Street 1:5 RICHFIELD CIRCLE
Practice Address - Street 2:
Practice Address - City:CARVER
Practice Address - State:MA
Practice Address - Zip Code:02330
Practice Address - Country:US
Practice Address - Phone:508-422-0404
Practice Address - Fax:508-422-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty