MEDICARE: MRS. WENDY DAWN RODRIGUEZ FNP-BC

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
1	363LF0000X	Family Nurse Practitioner	F3411181	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760925689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WENDY DAWN RODRIGUEZ FNP-BC

Provider Business Mailing Address
First Line	:	2570 ROUTE 9W STE 10
Second Line	:
City	:	CORNWALL
State	:	NY
Zip	:	12518-1370
Country	:	US
Telephone Number	:	845-220-3100
Fax Number	:	845-534-2940

Provider Business Practice Location Address
First Line	:	140 HAMMOND ST
Second Line	:
City	:	PORT JERVIS
State	:	NY
Zip	:	12771-2607
Country	:	US
Telephone Number	:	845-563-8000
Fax Number	:	845-858-2857

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2016
Last Update Date	:	10/27/2025

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