Provider Demographics
NPI:1932476637
Name:PROCTOR, WENDY V (FPMHNP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:V
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:FPMHNP
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:M
Other - Last Name:VANATTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FPMHNP
Mailing Address - Street 1:100 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-2849
Mailing Address - Country:US
Mailing Address - Phone:607-737-4796
Mailing Address - Fax:
Practice Address - Street 1:100 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2849
Practice Address - Country:US
Practice Address - Phone:607-737-4796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7512449363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health