Provider Demographics
NPI:1245603471
Name:WILSON, WENDY DEE (RDN, LD, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:DEE
Last Name:WILSON
Suffix:
Gender:F
Credentials:RDN, LD, IBCLC
Other - Prefix:MISS
Other - First Name:WENDY
Other - Middle Name:DEE
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:720 SW 156TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-7614
Mailing Address - Country:US
Mailing Address - Phone:405-615-0686
Mailing Address - Fax:
Practice Address - Street 1:720 SW 156TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-7614
Practice Address - Country:US
Practice Address - Phone:405-615-0686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-302871174N00000X
OK2098133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN