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General NPI Number Information
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NPI Number | 1891849139
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Entity Type | Individual
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Provider Name | WENDY L MEDEIROS-ANTHONY NP
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Gender | Female
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 07/10/2013
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Provider Practice Location Address
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Address Line | 233 CAREW ST
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City | SPRINGFIELD
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State | MA
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Zip | 01104-2377
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Country | US
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Telephone | 413-748-6800
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Fax | 413-748-6939
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Provider Business Mailing Address
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Address Line | 1275 ELM ST
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City | WEST SPRINGFIELD
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State | MA
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Zip | 01089-1820
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Country | US
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Telephone | 413-785-1153
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Fax | 413-781-4951
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 190636
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License Number State | MA
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