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General NPI Number Information
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NPI Number | 1053016642
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Entity Type | Individual
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Provider Name | NICOLE MARIE WEDEL FNP-C
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Gender | Female
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Dates
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Enumeration Date | 04/03/2023
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Last Update Date | 04/03/2023
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Provider Practice Location Address
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Address Line | 1303 N WASHINGTON ST
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City | WEATHERFORD
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State | OK
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Zip | 73096-2443
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Country | US
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Telephone | 580-772-2820
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Fax |
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Provider Business Mailing Address
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Address Line | 2706 CLOUD NINE CIR
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City | WEATHERFORD
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State | OK
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Zip | 73096-2627
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Country | US
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Telephone | 916-467-2507
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 212282
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License Number State | OK
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