Provider Demographics
NPI:1104437011
Name:WAIBEL, WENDY (FNP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:WAIBEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21015 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-2015
Mailing Address - Country:US
Mailing Address - Phone:503-669-6120
Mailing Address - Fax:503-669-6163
Practice Address - Street 1:21015 SE STARK ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-2015
Practice Address - Country:US
Practice Address - Phone:503-669-6120
Practice Address - Fax:503-669-6163
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202214629NP-PP363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily