Basic Information
| Provider Information | |||||||||
| NPI: | 1245328467 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZITZKA | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 155 LAWN AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142071816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168752904 | ||||||||
| FaxNumber: | 7168756717 | ||||||||
| Practice Location | |||||||||
| Address1: | 155 LAWN AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142071816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168752904 | ||||||||
| FaxNumber: | 7168756717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 05/18/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 420347 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 176B00000X | 000828 | NY | Y | Other Service Providers | Midwife |
ID Information
| ID | Type | State | Issuer | Description | 00026089401 | 01 | NY | UNIVERA | OTHER | 000560733001 | 01 | NY | BC/BS | OTHER | 000560733002 | 01 | NY | BC/BS | OTHER | 070517000063 | 01 | NY | FIDELIS | OTHER | 000560733003 | 01 | NY | BCBS | OTHER | 1899820 | 01 | NY | GHI PPO | OTHER | 040827000004 | 01 | NY | FIDELIS | OTHER | 00026089402 | 01 | NY | UNIVERA | OTHER | 01961733 | 05 | NY | MEDICAID | 9511816 | 01 | NY | INDEPENDENT HEALTH | OTHER | 150542-CQ | 01 | NY | PREFERRED CARE | OTHER |