1205013075 NPI number — WENDY L. FERRETTO APN

Table of content: WENDY L. FERRETTO APN (NPI 1205013075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205013075 NPI number — WENDY L. FERRETTO APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERRETTO
Provider First Name:
WENDY
Provider Middle Name:
L.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205013075
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
645 N ARLINGTON AVE
Provider Second Line Business Mailing Address:
#460
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89503-4505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-770-7403
Provider Business Mailing Address Fax Number:
775-770-3683

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
645 N ARLINGTON AVE
Provider Second Line Business Practice Location Address:
#460
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89503-4505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-770-7403
Provider Business Practice Location Address Fax Number:
775-770-3683
Provider Enumeration Date:
01/23/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  #APN 000975 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)