Provider Demographics
NPI:1932526803
Name:PAGANO, WENDY
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:
Last Name:PAGANO
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 1:1218 GRIEGOS RD NW
Mailing Address - Street 2:OPEN SKIES HEALTHCARE
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-3752
Mailing Address - Country:US
Mailing Address - Phone:505-345-8471
Mailing Address - Fax:505-342-5450
Practice Address - Street 1:1218 GRIEGOS RD NW
Practice Address - Street 2:OPEN SKIES HEALTHCARE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-3752
Practice Address - Country:US
Practice Address - Phone:505-345-8471
Practice Address - Fax:505-342-5450
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-073521041C0700X
CO9898591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical