Provider Demographics
NPI:1114166360
Name:ERSIG, WENDY SUE (ASSOCIATE)
Entity Type:Individual
Prefix:MISS
First Name:WENDY
Middle Name:SUE
Last Name:ERSIG
Suffix:
Gender:F
Credentials:ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11958 GREENWAY DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-2171
Mailing Address - Country:US
Mailing Address - Phone:586-215-7353
Mailing Address - Fax:
Practice Address - Street 1:11958 GREENWAY DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-2171
Practice Address - Country:US
Practice Address - Phone:586-215-7353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1287716172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker