Provider Demographics
NPI:1053208686
Name:FENNER, WENDY DAWN
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:DAWN
Last Name:FENNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4324 JERRY GILBERT CIR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-1114
Mailing Address - Country:US
Mailing Address - Phone:402-707-3146
Mailing Address - Fax:
Practice Address - Street 1:4324 JERRY GILBERT CIR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-1114
Practice Address - Country:US
Practice Address - Phone:402-707-3146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1053208686Medicaid