Provider Demographics
NPI:1164410049
Name:NOLES, WENDY (CRNA)
Entity Type:Individual
Prefix:MISS
First Name:WENDY
Middle Name:
Last Name:NOLES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 COPPER KETTLE CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-4456
Mailing Address - Country:US
Mailing Address - Phone:281-682-2295
Mailing Address - Fax:
Practice Address - Street 1:10 COPPER KETTLE CT
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-4456
Practice Address - Country:US
Practice Address - Phone:281-682-2295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX571607367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered