MEDICARE: KIRSTEN WELLMAN

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1932729555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN WELLMAN

Provider Business Mailing Address
First Line	:	2648 E 33RD ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16510-2714
Country	:	US
Telephone Number	:	814-636-4859
Fax Number	:

Provider Business Practice Location Address
First Line	:	2648 E 33RD ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16510-2714
Country	:	US
Telephone Number	:	814-636-4859
Fax Number	:

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

Provider Enumeration Date	:	04/23/2020
Last Update Date	:	04/23/2020

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Directions to “ KIRSTEN WELLMAN ” Practice Location

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