Healthcare Provider Details

I. General information

NPI: 1922409093
Provider Name (Legal Business Name): WENDY LYNN EDWARDS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 MAIN RD
CORFU NY
14036-9753
US

IV. Provider business mailing address

860 MAIN RD
CORFU NY
14036-9753
US

V. Phone/Fax

Practice location:
  • Phone: 585-599-6446
  • Fax: 585-599-3166
Mailing address:
  • Phone: 585-599-6446
  • Fax: 585-599-3166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number22672372
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: