Provider Demographics
NPI:1093794802
Name:ESCONTRIAS, WENDY G (ARNP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:G
Last Name:ESCONTRIAS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 E RUSHOLME ST STE 300
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2484
Mailing Address - Country:US
Mailing Address - Phone:563-324-2992
Mailing Address - Fax:563-324-8562
Practice Address - Street 1:1236 E RUSHOLME ST STE 300
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2484
Practice Address - Country:US
Practice Address - Phone:563-324-2992
Practice Address - Fax:563-324-8562
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA105513363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
500023677OtherMEDICARE RAILROAD
IA1015933Medicaid
IL201105Medicare PIN
IAI5478Medicare PIN
IA1015933Medicaid