Provider Demographics
NPI:1982827598
Name:HOLMES, WENDY (APRN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:HOLMES
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 1:455 LEWIS AVE
Mailing Address - Street 2:#102
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-2121
Mailing Address - Country:US
Mailing Address - Phone:203-238-7747
Mailing Address - Fax:203-686-0282
Practice Address - Street 1:455 LEWIS AVE
Practice Address - Street 2:#102
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-2121
Practice Address - Country:US
Practice Address - Phone:203-238-7747
Practice Address - Fax:203-686-0282
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003069363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTQ45049Medicare UPIN
CT500001486Medicare ID - Type Unspecified