Provider Demographics
NPI:1396938999
Name:WEBER-KULWICKI, NICOLE L (NP)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:L
Last Name:WEBER-KULWICKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:L
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-2600
Mailing Address - Fax:606-408-2603
Practice Address - Street 1:2245 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7848
Practice Address - Country:US
Practice Address - Phone:606-408-2600
Practice Address - Fax:606-408-2603
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI127235363L00000X
WI127235-030207P00000X
KY3006307363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3055652Medicaid
KY7100110070Medicaid
WV3810017359Medicaid
WI36055300Medicaid
OH3055652Medicaid
WI014002905Medicare PIN
WV3810017359Medicaid