Provider Demographics
NPI:1730490566
Name:WOLCOTT-TOBIAS, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:WOLCOTT-TOBIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 BATAVIA OKFLD TW RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-9499
Mailing Address - Country:US
Mailing Address - Phone:585-948-5809
Mailing Address - Fax:
Practice Address - Street 1:2821 BATAVIA OKFLD TW RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-9499
Practice Address - Country:US
Practice Address - Phone:585-948-5809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-26
Last Update Date:2010-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY544958163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse