Provider Demographics
NPI:1508415910
Name:FITZGERALD, WENDY LEE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LEE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 S WATER ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-4241
Mailing Address - Country:US
Mailing Address - Phone:304-263-8954
Mailing Address - Fax:304-264-0763
Practice Address - Street 1:235 S WATER ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-4241
Practice Address - Country:US
Practice Address - Phone:304-263-8954
Practice Address - Fax:304-264-0763
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV104262363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner