Provider Demographics
NPI:1104455229
Name:STAVENHAGEN, WENDY ARMBRUSTER
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:ARMBRUSTER
Last Name:STAVENHAGEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12949 WHITE CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:NY
Mailing Address - Zip Code:13074-9508
Mailing Address - Country:US
Mailing Address - Phone:315-506-3711
Mailing Address - Fax:315-626-3446
Practice Address - Street 1:2851 ROUTE 370
Practice Address - Street 2:
Practice Address - City:CATO
Practice Address - State:NY
Practice Address - Zip Code:13033
Practice Address - Country:US
Practice Address - Phone:315-626-3320
Practice Address - Fax:315-626-3446
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY453522163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool