Individual provider Active NPI

Nancy Vendura, PNP

  • Pediatric Nurse Practitioner
  • Pine Bush, NY
National Provider Identifier
1184716987
Registry record updated Aug 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
F380948 Issued in NY
Practice address
99 Cameron St
Pine Bush, NY 12566-7113
Phone
(845) 343-7614
Fax
(845) 343-5390
NPI assigned
Sep 29, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X F380948 NY Primary

Addresses

Primary practice location

99 Cameron St
Pine Bush, NY 12566-7113

Mailing address

21 Orchard St
PO Box 987
Middletown, NY 10940-5004
Phone (845) 343-7614

Other identifiers 2

IdentifierTypeStateIssuer
00473038MedicaidNY
00355931MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
F380948NYMDPediatric Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219708800000",
    "number": "1184716987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 ORCHARD ST",
            "address_2": "PO BOX 987",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109405004",
            "telephone_number": "845-343-7614",
            "fax_number": "845-343-5390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 CAMERON ST",
            "city": "PINE BUSH",
            "state": "NY",
            "postal_code": "125667113",
            "telephone_number": "845-343-7614",
            "fax_number": "845-343-5390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VENDURA",
        "first_name": "NANCY",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-29",
        "last_updated": "2008-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NY",
            "license": "F380948",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00473038",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00355931",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pine Bush, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.