Provider Demographics
NPI:1225271703
Name:JACK - SINGH, WENDY -ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:WENDY -ANN
Middle Name:
Last Name:JACK - SINGH
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 1:451 GRANITE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-6404
Mailing Address - Country:US
Mailing Address - Phone:617-605-5089
Mailing Address - Fax:
Practice Address - Street 1:451 GRANITE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-6404
Practice Address - Country:US
Practice Address - Phone:617-605-5089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN184740163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse