Provider Demographics
NPI:1508024894
Name:MURAKAMI, WENDY MIEKO (APRN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:MIEKO
Last Name:MURAKAMI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-5242
Mailing Address - Country:US
Mailing Address - Phone:860-646-0166
Mailing Address - Fax:860-645-7534
Practice Address - Street 1:375 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4445
Practice Address - Country:US
Practice Address - Phone:860-646-0166
Practice Address - Fax:860-645-7534
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001156363LG0600X
CTR50878163W00000X
MA184911363L00000X
CT1156363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S47357OtherUPIN
CT00413802Medicaid