Healthcare Provider Details

I. General information

NPI: 1972660611
Provider Name (Legal Business Name): MRS. WENDY TOMCZAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 LLEWELLYN AVE
FORT GEORGE G MEADE MD
20755-5800
US

IV. Provider business mailing address

2480 LLEWELLYN AVE
FORT GEORGE G MEADE MD
20755-5800
US

V. Phone/Fax

Practice location:
  • Phone: 301-677-8270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberRN175236L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: