MEDICARE: MS. NANCY G. WESSON P.A.-C

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	363AS0400X	Surgical Physician Assistant	001948-1	NY

General Provider Information

NPI Number	:	1558359141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY G. WESSON P.A.-C

Provider Business Mailing Address
First Line	:	5 CAVENDISH PL
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14625-2907
Country	:	US
Telephone Number	:	585-787-0047
Fax Number	:

Provider Business Practice Location Address
First Line	:	1425 PORTLAND AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-3001
Country	:	US
Telephone Number	:	585-922-4500
Fax Number	:

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

Provider Enumeration Date	:	10/08/2005
Last Update Date	:	05/05/2021

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