Healthcare Provider Details

I. General information

NPI: 1104353309
Provider Name (Legal Business Name): WENDY ANN LUNNY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 CHALKSTONE AVE
PROVIDENCE RI
02908-4734
US

IV. Provider business mailing address

5 INMAN ST
HOPEDALE MA
01747-1109
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-7100
  • Fax:
Mailing address:
  • Phone: 999-999-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number179892
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN179892
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: