MEDICARE: MRS. WENDY APRIL MANIS RN

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	163WS0200X	School Registered Nurse	552423	NY

General Provider Information

NPI Number	:	1811263445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WENDY APRIL MANIS RN

Provider Business Mailing Address
First Line	:	112 GRAND AVE
Second Line	:
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-3804
Country	:	US
Telephone Number	:	845-326-1638
Fax Number	:	845-326-1636

Provider Business Practice Location Address
First Line	:	112 GRAND AVE
Second Line	:
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-3804
Country	:	US
Telephone Number	:	845-326-1638
Fax Number	:	845-326-1636

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

Provider Enumeration Date	:	03/28/2012
Last Update Date	:	03/28/2012

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