Provider Demographics
NPI:1801889449
Name:FARACE, WENDY LEE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:LEE
Last Name:FARACE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:WENDY
Other - Middle Name:LEE
Other - Last Name:BROTKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1061 HARMON AVE
Mailing Address - Street 2:
Mailing Address - City:FT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5604
Mailing Address - Country:US
Mailing Address - Phone:912-435-5111
Mailing Address - Fax:
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:
Practice Address - City:FT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5604
Practice Address - Country:US
Practice Address - Phone:912-435-5902
Practice Address - Fax:912-435-5059
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN109775NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner