Provider Demographics
NPI:1518110410
Name:WENDT, TRACY LYNN (NP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:WENDT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8330 CODYS CORS
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-7921
Mailing Address - Country:US
Mailing Address - Phone:315-288-4191
Mailing Address - Fax:
Practice Address - Street 1:5355 W TAFT RD
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-2767
Practice Address - Country:US
Practice Address - Phone:315-218-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY453895-1163W00000X
NYF332693-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily