Healthcare Provider Details

I. General information

NPI: 1922860915
Provider Name (Legal Business Name): CHARLENE ELIZABETH WELSTED AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MAIN ST
ARCADE NY
14009-1113
US

IV. Provider business mailing address

1359 CROSS RD
FREEDOM NY
14065-9409
US

V. Phone/Fax

Practice location:
  • Phone: 585-492-5088
  • Fax:
Mailing address:
  • Phone: 716-860-1310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number311682
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: