Healthcare Provider Details

I. General information

NPI: 1891098141
Provider Name (Legal Business Name): WYOMING WOMEN'S HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 N MAIN ST
WARSAW NY
14569-1015
US

IV. Provider business mailing address

408 N MAIN ST
WARSAW NY
14569-1015
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-7926
  • Fax: 585-786-7993
Mailing address:
  • Phone: 585-786-7926
  • Fax: 585-786-7993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number196428
License Number StateNY

VIII. Authorized Official

Name: DR. GARY JOHN NICHOLSON
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 585-786-7926