Provider Demographics
NPI:1629367024
Name:JOHNSON, WENDY MARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 MAIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-1363
Mailing Address - Country:US
Mailing Address - Phone:518-719-3580
Mailing Address - Fax:518-719-3797
Practice Address - Street 1:411 MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414
Practice Address - Country:US
Practice Address - Phone:518-719-3580
Practice Address - Fax:518-719-3797
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY536360-1163WW0101X
NY343224363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory