Provider Demographics
NPI:1548698350
Name:CUDWORTH MAGNAN, WENDY L (RN)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:L
Last Name:CUDWORTH MAGNAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 COUNTY ROUTE 35
Mailing Address - Street 2:
Mailing Address - City:CHATEAUGAY
Mailing Address - State:NY
Mailing Address - Zip Code:12920-3409
Mailing Address - Country:US
Mailing Address - Phone:518-497-0031
Mailing Address - Fax:
Practice Address - Street 1:23 HUSKIE LN
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-2450
Practice Address - Country:US
Practice Address - Phone:518-483-5320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22588739390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program