Provider Demographics
NPI:1003064379
Name:TULLY, WENDY LOU (RN)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:LOU
Last Name:TULLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27046 OAKWOOD CIR
Mailing Address - Street 2:APT.201
Mailing Address - City:OLMSTED FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44138-3136
Mailing Address - Country:US
Mailing Address - Phone:440-235-1669
Mailing Address - Fax:
Practice Address - Street 1:27046 OAKWOOD CIR
Practice Address - Street 2:APT.201
Practice Address - City:OLMSTED FALLS
Practice Address - State:OH
Practice Address - Zip Code:44138-3136
Practice Address - Country:US
Practice Address - Phone:440-235-1669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN253682163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse