MEDICARE: WENDY CHASE RPA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	004745	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	9511783	OTHER	NY	INDEPENDENT HEALTH
3	000570040003	OTHER	NY	BCBSWNY
4	00026510102	OTHER		UNIVERA

General Provider Information

NPI Number	:	1144299827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY CHASE RPA-C

Provider Business Mailing Address
First Line	:	95 E CHAUTAUQUA ST
Second Line	:	PO BOX 168
City	:	MAYVILLE
State	:	NY
Zip	:	14757-1017
Country	:	US
Telephone Number	:	716-753-7107
Fax Number	:	716-753-7980

Provider Business Practice Location Address
First Line	:	95 E CHAUTAUQUA ST
Second Line	:
City	:	MAYVILLE
State	:	NY
Zip	:	14757-1017
Country	:	US
Telephone Number	:	716-753-7107
Fax Number	:	716-753-7980

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	07/27/2007

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Directions to “ WENDY CHASE RPA-C” Practice Location

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