MEDICARE: KRISTI MARIE WELKLEY RN BSN

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	163W00000X	Registered Nurse	777691	NY

General Provider Information

NPI Number	:	1861085516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI MARIE WELKLEY RN BSN

Provider Business Mailing Address
First Line	:	11400 SALTER COLVIN RD
Second Line	:
City	:	WOLCOTT
State	:	NY
Zip	:	14590-9331
Country	:	US
Telephone Number	:	315-263-7363
Fax Number	:

Provider Business Practice Location Address
First Line	:	7231 JACKSON HILL RD
Second Line	:
City	:	NEWARK
State	:	NY
Zip	:	14513-9111
Country	:	US
Telephone Number	:	315-945-3545
Fax Number	:

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

Provider Enumeration Date	:	02/13/2021
Last Update Date	:	02/13/2021

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