Provider Demographics
NPI:1164927265
Name:HERTLINE, WENDY A (RN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:A
Last Name:HERTLINE
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 1:8520 TRENTON FALLS PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:REMSEN
Mailing Address - State:NY
Mailing Address - Zip Code:13438-2909
Mailing Address - Country:US
Mailing Address - Phone:315-896-4921
Mailing Address - Fax:
Practice Address - Street 1:8520 TRENTON FALLS PROSPECT RD
Practice Address - Street 2:
Practice Address - City:REMSEN
Practice Address - State:NY
Practice Address - Zip Code:13438-2909
Practice Address - Country:US
Practice Address - Phone:315-896-4921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY477682-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse