Provider Demographics
NPI:1235314303
Name:WENDY E MARTIN
Entity Type:Organization
Organization Name:WENDY E MARTIN
Other - Org Name:WENDY MARTIN ANP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADULT NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:EVELYN
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN ANP
Authorized Official - Phone:315-895-4050
Mailing Address - Street 1:8736 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13431-2305
Mailing Address - Country:US
Mailing Address - Phone:315-624-3491
Mailing Address - Fax:315-624-3478
Practice Address - Street 1:525 FRENCH RD.
Practice Address - Street 2:CONMED HEALTH CENTER
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502
Practice Address - Country:US
Practice Address - Phone:315-624-3491
Practice Address - Fax:315-624-3478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302575261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMM0420101OtherDEA NUMBER