Provider Demographics
NPI:1871687459
Name:SERGEANT, WENDY ANN (NP, DNP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ANN
Last Name:SERGEANT
Suffix:
Gender:F
Credentials:NP, DNP
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:ANN
Other - Last Name:CRANSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 576
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05342-0576
Mailing Address - Country:US
Mailing Address - Phone:802-435-0616
Mailing Address - Fax:508-637-1605
Practice Address - Street 1:163 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH BROOKFIELD
Practice Address - State:MA
Practice Address - Zip Code:01535-1400
Practice Address - Country:US
Practice Address - Phone:508-637-1604
Practice Address - Fax:508-637-1605
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TP0016X
MA273780363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA8775673130Medicare NSC