MEDICARE: NICOLE J WELCH FNP

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	345616	NY

General Provider Information

NPI Number	:	1952928004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE J WELCH FNP

Provider Business Mailing Address
First Line	:	PO BOX 14890
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12212-4890
Country	:	US
Telephone Number	:	518-525-5634
Fax Number	:

Provider Business Practice Location Address
First Line	:	2232 LYELL AVE
Second Line	:
City	:	GATES
State	:	NY
Zip	:	14606-5720
Country	:	US
Telephone Number	:	585-417-4125
Fax Number	:

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

Provider Enumeration Date	:	07/06/2020
Last Update Date	:	06/01/2021

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