MEDICARE: EVELYN OUELLETTE CRNP

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	363LF0000X	Family Nurse Practitioner	F334898-01	NY

General Provider Information

NPI Number	:	1770586398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYN OUELLETTE CRNP

Provider Business Mailing Address
First Line	:	117 MAIN STREET
Second Line	:
City	:	SALAMANCA
State	:	NY
Zip	:	14779-1529
Country	:	US
Telephone Number	:	716-945-5500
Fax Number	:	716-945-5506

Provider Business Practice Location Address
First Line	:	117 MAIN ST
Second Line	:
City	:	SALAMANCA
State	:	NY
Zip	:	14779-1529
Country	:	US
Telephone Number	:	716-945-5500
Fax Number	:	716-945-5506

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/13/2021

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