MEDICARE: VICKI M WLOCK NP

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	163W00000X	Registered Nurse	370695	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508826322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI M WLOCK NP

Provider Business Mailing Address
First Line	:	915 ORCHARD DR
Second Line	:
City	:	LEWISTON
State	:	NY
Zip	:	14092-1815
Country	:	US
Telephone Number	:	716-523-0539
Fax Number	:

Provider Business Practice Location Address
First Line	:	6934 WILLIAMS RD
Second Line	:	SUITE 500
City	:	NIAGARA FALLS
State	:	NY
Zip	:	14304-3080
Country	:	US
Telephone Number	:	716-297-7898
Fax Number	:

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	10/16/2015

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