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General NPI Number Information
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NPI Number | 1215804869
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Entity Type | Individual
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Provider Name | JOAN ALICE WLAD
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Gender |
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Dates
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Enumeration Date | 10/20/2025
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 2 N HERMAN AVE
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City | AUBURN
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State | NY
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Zip | 13021-2945
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Country | US
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Telephone | 315-255-8686
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Fax |
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Provider Business Mailing Address
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Address Line | 4903 ROCKEFELLER RD
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City | AUBURN
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State | NY
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Zip | 13021-8674
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Country | US
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Telephone | 315-255-8855
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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 | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | 382921
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License Number State | NY
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