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General NPI Number Information
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NPI Number | 1073121679
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Entity Type | Individual
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Provider Name | NELSON WYCHE WEBB III PARAMEDIC
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Gender | Male
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 07/30/2020
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Provider Practice Location Address
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Address Line | 4901 BIG OAK TRAIL DR
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City | TROY
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State | MI
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Zip | 48098-4152
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Country | US
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Telephone | 248-425-1918
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Fax |
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Provider Business Mailing Address
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Address Line | 4901 BIG OAK TRAIL DR
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City | TROY
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State | MI
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Zip | 48098-4152
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Country | US
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Telephone | 248-425-1918
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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 | 146L00000X
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Taxonomy Name | Paramedic
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License Number | A038916
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 146M00000X
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Taxonomy Name | Intermediate Emergency Medical Technician
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License Number |
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License Number State |
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