Provider Demographics
NPI:1699441410
Name:DUBOIS, WENDY (RN, MSN, MHA)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:RN, MSN, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 DUNBARTON RD APT 4
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-6522
Mailing Address - Country:US
Mailing Address - Phone:603-540-2338
Mailing Address - Fax:
Practice Address - Street 1:186 DUNBARTON RD APT 4
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-6522
Practice Address - Country:US
Practice Address - Phone:603-540-2338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH055697-21163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN278251OtherRN LICENSE
NH055697-21OtherRN LICENSE