Provider Demographics
NPI:1982075933
Name:VICKI WLOCK, WOMEN'S HEALTH NURSE PRACTITIONER, P.C.
Entity Type:Organization
Organization Name:VICKI WLOCK, WOMEN'S HEALTH NURSE PRACTITIONER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:M
Authorized Official - Last Name:WLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:716-523-0539
Mailing Address - Street 1:915 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-1815
Mailing Address - Country:US
Mailing Address - Phone:716-523-0539
Mailing Address - Fax:
Practice Address - Street 1:7220 PORTER RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-1600
Practice Address - Country:US
Practice Address - Phone:716-523-0539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty