Provider Demographics
NPI:1760676530
Name:WEGMAN, ELEANOE R (RN)
Entity Type:Individual
Prefix:
First Name:ELEANOE
Middle Name:R
Last Name:WEGMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MEADOW WOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-2837
Mailing Address - Country:US
Mailing Address - Phone:585-388-2015
Mailing Address - Fax:
Practice Address - Street 1:18 MEADOW WOOD DR
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-2837
Practice Address - Country:US
Practice Address - Phone:585-388-2015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256253163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse