1235314303 NPI number — WENDY E MARTIN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235314303 NPI number — WENDY E MARTIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WENDY E MARTIN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WENDY MARTIN ANP
Provider Other Organization Name Type Code:
3
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:
1235314303
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8736 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13431-2305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-624-3491
Provider Business Mailing Address Fax Number:
315-624-3478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 FRENCH RD.
Provider Second Line Business Practice Location Address:
CONMED HEALTH CENTER
Provider Business Practice Location Address City Name:
UTICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-624-3491
Provider Business Practice Location Address Fax Number:
315-624-3478
Provider Enumeration Date:
01/08/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
WENDY
Authorized Official Middle Name:
EVELYN
Authorized Official Title or Position:
ADULT NURSE PRACTITIONER
Authorized Official Telephone Number:
315-895-4050

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  F302575 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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