Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | R164748 | MD |
N | 208D00000X | General Practice Physician | R164748 | MD |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 0024170671 | VA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | R164748 | MD |
NPI | 1649515818 |
---|---|
Provider Name | Dr. Wendy Kaye Drys |
First Address | Hollywood, MD 20636-2949 |
Second Address | Hollywood, MD 20636-2949 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2012 |
Last Update Date | 03/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0024170671 | BOARD OF NURSING (01) | VA |
800088744 | (05) | MD |
MD3154755 | MARYLAND DEA (01) | |
N80116 | MARYLAND CDS (01) | MD |
R164748 | BOARD OF NURSING (01) | MD |
XD3154755 | DEA X-WAIVER (01) |