MEDICARE: MS. PATRICIA CLEARY WIELICZKO APRN

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	26NC07343000	NJ

General Provider Information

NPI Number	:	1326153123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA CLEARY WIELICZKO APRN

Provider Business Mailing Address
First Line	:	513 GAYLE DR
Second Line	:
City	:	YARDLEY
State	:	PA
Zip	:	19067-5620
Country	:	US
Telephone Number	:	215-321-6963
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 N CLINTON AVE
Second Line	:
City	:	TRENTON
State	:	NJ
Zip	:	08609-1011
Country	:	US
Telephone Number	:	609-394-9398
Fax Number	:

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/08/2007

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