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NPI Code Detail

MEDICARE: TRACY LYNN WENDT NP

MEDICARE:   TRACY LYNN WENDT  NP
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
1163W00000XRegistered Nurse453895-1NY
2363LF0000XFamily Nurse PractitionerF332693-1NY

General Provider Information

NPI Number : 1518110410
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY LYNN WENDT NP
Provider Business Mailing Address
First Line : 8330 CODYS CORS
Second Line :
City : CICERO
State : NY
Zip : 13039-7921
Country : US
Telephone Number : 315-288-4191
Fax Number :
Provider Business Practice Location Address
First Line : 5355 W TAFT RD
Second Line :
City : NORTH SYRACUSE
State : NY
Zip : 13212-2767
Country : US
Telephone Number : 315-218-2100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2008
Last Update Date : 10/05/2011

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