MEDICARE: NICOLE WU ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	2791	NC

General Provider Information

NPI Number	:	1023567948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE WU ATC

Provider Business Mailing Address
First Line	:	4015 SPRING MILL PL
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40245-7474
Country	:	US
Telephone Number	:	502-802-4940
Fax Number	:

Provider Business Practice Location Address
First Line	:	9115 FERN CREEK RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-2799
Country	:	US
Telephone Number	:	502-485-8251
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2016
Last Update Date	:	08/20/2023

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