Joella Lange
Individual provider Active NPI Registered Nurse · Wolcott, NY
NPI 1851014609 · NPPES record last updated Sep 26, 2022
Key facts
- NPI
- 1851014609
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 751145-01 (NY)
- Practice address
- 5048 Gaylord Rd
Wolcott, NY 14590-9305 - Phone
- (585) 642-0900
- NPI assigned
- Sep 26, 2022
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 751145-01 | NY | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 751145-01 | NY | Yes |
Addresses
Primary practice location
5048 Gaylord Rd
Wolcott, NY 14590-9305
Mailing address
5048 Gaylord Rd
Wolcott, NY 14590-9305
Other providers in Wolcott, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.