Provider Demographics
NPI:1205398971
Name:WENDEBORN, MARNI SAIGE (FNP)
Entity Type:Individual
Prefix:
First Name:MARNI
Middle Name:SAIGE
Last Name:WENDEBORN
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 1:3410 98TH ST STE 4-143
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-3847
Mailing Address - Country:US
Mailing Address - Phone:352-246-6385
Mailing Address - Fax:
Practice Address - Street 1:4003 113TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1979
Practice Address - Country:US
Practice Address - Phone:523-246-6385
Practice Address - Fax:432-758-4761
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX813477363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX023219102Medicaid