Provider Demographics
NPI:1669742904
Name:DIDAS, WENDY P (RN)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:P
Last Name:DIDAS
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 1:284 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-9753
Mailing Address - Country:US
Mailing Address - Phone:585-335-4040
Mailing Address - Fax:585-335-4059
Practice Address - Street 1:284 MAIN ST
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-9753
Practice Address - Country:US
Practice Address - Phone:585-335-4040
Practice Address - Fax:585-335-4059
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY486156163WS0200X, 163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient