Provider Demographics
NPI:1023377470
Name:WENDELL, NATHAN S (LAC)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:S
Last Name:WENDELL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 PARK AVE SW
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:OH
Mailing Address - Zip Code:44612
Mailing Address - Country:US
Mailing Address - Phone:720-352-1268
Mailing Address - Fax:
Practice Address - Street 1:148 PARK AVE SW
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:OH
Practice Address - Zip Code:44612
Practice Address - Country:US
Practice Address - Phone:720-352-1268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1483171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist