Individual
WENDY C. FENNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
345 BLACKSTONE BLVD, PROVIDENCE, RI 02906-4800
(401) 455-6200
(401) 455-6404
Mailing address
345 BLACKSTONE BLVD, PROVIDENCE, RI 02906-4800
(401) 455-6200
(401) 455-6404
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
64
RI
363AM0700X
Medical Physician Assistant
64
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33164-7
BCBS
RI
01
—
414051
BLUECHIP
RI
05
—
WF68506
—
RI
Enumeration date
07/10/2007
Last updated
06/13/2008
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