Provider Demographics
NPI:1619577764
Name:MCCARTY, WENDY KAY (CDAC PROVIDOR)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:KAY
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:CDAC PROVIDOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-1541
Mailing Address - Country:US
Mailing Address - Phone:641-954-2646
Mailing Address - Fax:
Practice Address - Street 1:2270 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-1541
Practice Address - Country:US
Practice Address - Phone:641-954-2646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care