Provider Demographics
NPI:1114511557
Name:WEISS, WENDY SUE (RN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:SUE
Last Name:WEISS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2803
Mailing Address - Country:US
Mailing Address - Phone:516-432-8285
Mailing Address - Fax:
Practice Address - Street 1:523 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2803
Practice Address - Country:US
Practice Address - Phone:516-432-8285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341646-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool