Provider Demographics
NPI:1013355189
Name:WOLCOTT, KATHERINE (FNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:WOLCOTT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 LAKE AVE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-5758
Mailing Address - Country:US
Mailing Address - Phone:585-254-1850
Mailing Address - Fax:
Practice Address - Street 1:2260 LAKE AVE
Practice Address - Street 2:SUITE 1000
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-5758
Practice Address - Country:US
Practice Address - Phone:585-254-1850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY602263163W00000X
NY337959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03617416Medicaid
NY03617416Medicaid
NYJ400088688/GP BA0017Medicare PIN