Provider Demographics
NPI:1124450291
Name:DEMETRIOS, WENDY ANN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:ANN
Last Name:DEMETRIOS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 NILES CORTLAND RD SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2475
Mailing Address - Country:US
Mailing Address - Phone:330-856-6365
Mailing Address - Fax:330-609-5088
Practice Address - Street 1:735 NILES CORTLAND RD SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2475
Practice Address - Country:US
Practice Address - Phone:330-856-6365
Practice Address - Fax:330-609-5088
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.14894-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily