Provider Demographics
NPI:1245328467
Name:ZITZKA, WENDY E (CNM)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:E
Last Name:ZITZKA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14207-1816
Mailing Address - Country:US
Mailing Address - Phone:716-875-2904
Mailing Address - Fax:716-875-6717
Practice Address - Street 1:155 LAWN AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14207-1816
Practice Address - Country:US
Practice Address - Phone:716-875-2904
Practice Address - Fax:716-875-6717
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY420347363LW0102X
NY000828176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026089401OtherUNIVERA
NY000560733001OtherBC/BS
NY000560733002OtherBC/BS
NY070517000063OtherFIDELIS
NY000560733003OtherBCBS
NY1899820OtherGHI PPO
NY040827000004OtherFIDELIS
NY00026089402OtherUNIVERA
NY01961733Medicaid
NY9511816OtherINDEPENDENT HEALTH
NY150542-CQOtherPREFERRED CARE
RB8238Medicare PIN
NY00026089402OtherUNIVERA
NY070517000063OtherFIDELIS