Provider Demographics
NPI:1760754071
Name:GACEK, WENDY (APRN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:GACEK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 WOODLAND STREET
Mailing Address - Street 2:DEPT OF SURGERY
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105
Mailing Address - Country:US
Mailing Address - Phone:860-714-4694
Mailing Address - Fax:860-714-8096
Practice Address - Street 1:1000 ASYLUM AVENUE
Practice Address - Street 2:SUITE 2109A
Practice Address - City:HARFORD
Practice Address - State:CT
Practice Address - Zip Code:06105
Practice Address - Country:US
Practice Address - Phone:860-714-5058
Practice Address - Fax:860-714-8311
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4436363L00000X, 363LA2100X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care