Provider Demographics
NPI:1215405576
Name:WANDELL, STEVE
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:WANDELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3647 HIGHWAY 39
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-2612
Mailing Address - Country:US
Mailing Address - Phone:541-884-5244
Mailing Address - Fax:541-884-1105
Practice Address - Street 1:3647 HIGHWAY 39
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-2612
Practice Address - Country:US
Practice Address - Phone:541-884-5244
Practice Address - Fax:541-884-1105
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist