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General NPI Number Information
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NPI Number | 1164750410
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Entity Type | Individual
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Provider Name | ROCHELE MARIE NICOLAS-WEDIGE FNP
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Gender | Female
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Dates
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Enumeration Date | 11/25/2009
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Last Update Date | 06/09/2021
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Provider Practice Location Address
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Address Line | 418 N LOOP 1604 W
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City | SAN ANTONIO
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State | TX
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Zip | 78232
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Country | US
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Telephone | 210-595-1019
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Fax | 210-493-2900
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Provider Business Mailing Address
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Address Line | 418 N LOOP 1604 W
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City | SAN ANTONIO
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State | TX
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Zip | 78232-1456
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Country | US
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Telephone | 210-595-1019
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Fax | 210-493-2900
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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 | 713314
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License Number State | TX
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