Provider Demographics
NPI:1013226497
Name:WENDT, THERESA LYNN (APNP)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:LYNN
Last Name:WENDT
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MISS
Other - First Name:THERESA
Other - Middle Name:LYNN
Other - Last Name:WENDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:6001W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53213-1527
Mailing Address - Country:US
Mailing Address - Phone:414-771-6315
Mailing Address - Fax:
Practice Address - Street 1:8136 S MISSION DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-2353
Practice Address - Country:US
Practice Address - Phone:414-861-4875
Practice Address - Fax:414-427-9711
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3968-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner