Provider Demographics
NPI:1801103031
Name:DEANE, WENDY (RN)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:
Last Name:DEANE
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 1:254 BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-1704
Mailing Address - Country:US
Mailing Address - Phone:917-476-9087
Mailing Address - Fax:516-771-0217
Practice Address - Street 1:254 BROOKSIDE AVE
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:NY
Practice Address - Zip Code:11575-1704
Practice Address - Country:US
Practice Address - Phone:917-476-9087
Practice Address - Fax:516-771-0217
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY506341163W00000X, 163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development