MEDICARE: NICOLE WARD MA

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	101YM0800X	Mental Health Counselor	PC007753	PA

General Provider Information

NPI Number	:	1457174765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE WARD MA

Provider Business Mailing Address
First Line	:	5601 BEAR RUN CIR
Second Line	:
City	:	FAIRVIEW
State	:	PA
Zip	:	16415-3804
Country	:	US
Telephone Number	:	724-584-1065
Fax Number	:

Provider Business Practice Location Address
First Line	:	1915 E 38TH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16510-3573
Country	:	US
Telephone Number	:	814-636-9342
Fax Number	:

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

Provider Enumeration Date	:	11/05/2024
Last Update Date	:	11/05/2024

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Directions to “ NICOLE WARD MA” Practice Location

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