Basic Information
| Provider Information | |||||||||
| NPI: | 1669559183 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DREW | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APRN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MCGANN | ||||||||
| OtherFirstName: | WENDY | ||||||||
| OtherMiddleName: | DREW | ||||||||
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| OtherCredential: | RN, BSN, CDC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 100 HITCHCOCK WAY | ||||||||
| Address2: | DARTMOUTH HITCHCOCK - ENDOCRINOLOGY | ||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031044125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036952500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 HITCHCOCK WAY | ||||||||
| Address2: | DARTMOUTH HITCHCOCK - ENDOCRINOLOGY | ||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031044125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036952500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 03/22/2017 | ||||||||
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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 | 163WD0400X | 055561-21 | NH | N | Nursing Service Providers | Registered Nurse | Diabetes Educator | 364SA2200X | AS114003 | ME | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health | 363LA2200X | 055561-23 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 3081008 | 05 | NH | MEDICAID |