NPIMap

Individual provider Active NPI

Nicole Gia Waetzman, CRNP

  • Nurse Practitioner
  • West Chester, PA
National Provider Identifier
1588918957
Registry record updated Jul 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
SP012471 Issued in PA
Practice address
915 Old Fern Hill Rd
Ste 202
West Chester, PA 19380-3431
Phone
(610) 692-4270
Fax
(610) 692-5443
NPI assigned
Nov 6, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X SP012471 PA Primary

Addresses

Primary practice location

915 Old Fern Hill Rd
Ste 202
West Chester, PA 19380-3431

Mailing address

PO Box 22581
New York, NY 10087-2581
Phone (610) 482-4795

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nicole.waetzman@axia.eclinicaldirectplus.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161019002785 PA Practitioner - Nurse Practitioner 9335437615 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians
Regional Womens Health Group LLCGroup PAC ID 2961316328, 352 clinicians

Practice addresses (Care Compare)

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

919 Conestoga Rd
Suite 104
Bryn Mawr, PA 19010-1352
Phone (610) 525-6400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP012471PAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Physician Services, PC / Dba Midlantic Urology CurrentSince Oct 1, 2017 Accepting new patients
Regional Womens Health Group LLC CurrentSince Nov 4, 2019 Accepting new patients
Alliance Physician Services, PC Current Accepting new patients
Alliance Physician Services, PC CurrentSince Oct 1, 2017 Accepting new patients
Regional Women'S Health Group, LLC Nurse Practitioner PastSince Jul 17, 2021 Accepting new patients

Locations

919 Conestoga Rd
Bldg 1
Bryn Mawr, PA 19010
Phone (610) 525-6400

919 Conestoga Rd
Ste 104
Bryn Mawr, PA 19010
Phone (610) 525-6400

211 S Gulph Rd
Ste 200
Kng of Prussa, PA 19406
Phone (610) 382-5910

915 Old Fern Hill Rd
Ste 202
West Chester, PA 19380
Phone (610) 579-3577

915 Old Fern Hill Rd
Bldg B
West Chester, PA 19380
Phone (610) 696-1230

Interoperability endpoints

  • Direct secure messaging: nicole.waetzman@axia.eclinicaldirectplus.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1352160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625702400000",
    "number": "1588918957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22581",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100872581",
            "telephone_number": "610-482-4795",
            "fax_number": "856-528-3117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 OLD FERN HILL RD",
            "address_2": "STE 202",
            "city": "WEST CHESTER",
            "state": "PA",
            "postal_code": "193803431",
            "telephone_number": "610-692-4270",
            "fax_number": "610-692-5443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAETZMAN",
        "first_name": "NICOLE",
        "middle_name": "GIA",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-06",
        "last_updated": "2021-07-08",
        "certification_date": "2021-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP012471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nicole.waetzman@axia.eclinicaldirectplus.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "915 OLD FERN HILL RD",
            "address_2": "STE 202",
            "city": "WEST CHESTER",
            "state": "PA",
            "country_code": "US",
            "postal_code": "193803431",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in West Chester, PA

Sources for this page

Verify at the official NPI Registry.