Provider Demographics
NPI:1184947079
Name:MASTON, WENDY (LPN)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:
Last Name:MASTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12059 MCKINSTRY RD
Mailing Address - Street 2:
Mailing Address - City:CHAFFEE
Mailing Address - State:NY
Mailing Address - Zip Code:14030-9605
Mailing Address - Country:US
Mailing Address - Phone:716-496-9008
Mailing Address - Fax:
Practice Address - Street 1:700 W STATE ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2346
Practice Address - Country:US
Practice Address - Phone:716-373-9755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219054164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse