Provider Demographics
NPI:1790380095
Name:DENNIS, WAYNE HARDIE (NP)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:HARDIE
Last Name:DENNIS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-239-7300
Mailing Address - Fax:585-227-7723
Practice Address - Street 1:101 CANAL LANDING BLVD STE 8
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-5109
Practice Address - Country:US
Practice Address - Phone:585-239-7300
Practice Address - Fax:585-227-7723
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY431788363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care