MEDICARE: JOAN ALICE WLAD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	382921	NY

General Provider Information

NPI Number	:	1215804869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN ALICE WLAD

Provider Business Mailing Address
First Line	:	4903 ROCKEFELLER RD
Second Line	:
City	:	AUBURN
State	:	NY
Zip	:	13021-8674
Country	:	US
Telephone Number	:	315-255-8855
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 N HERMAN AVE
Second Line	:
City	:	AUBURN
State	:	NY
Zip	:	13021-2945
Country	:	US
Telephone Number	:	315-255-8686
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2025
Last Update Date	:	10/20/2025

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Directions to “ JOAN ALICE WLAD ” Practice Location

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