Provider Demographics
NPI:1164656260
Name:REAGAN, WENDI (CPNP)
Entity Type:Individual
Prefix:
First Name:WENDI
Middle Name:
Last Name:REAGAN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 E COMMON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3154
Mailing Address - Country:US
Mailing Address - Phone:830-625-9153
Mailing Address - Fax:830-609-0572
Practice Address - Street 1:1535 E COMMON ST
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3154
Practice Address - Country:US
Practice Address - Phone:830-625-9153
Practice Address - Fax:830-609-0572
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX682715363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics