Provider Demographics
NPI:1255304184
Name:MARKOVICH, WENDY LEA (NP)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:LEA
Last Name:MARKOVICH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:WENDY
Other - Middle Name:LEA
Other - Last Name:LONGCHAMPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:8414 E. SHEA BOULEVARD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:480-917-7800
Mailing Address - Fax:480-917-8500
Practice Address - Street 1:8414 E SHEA BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260
Practice Address - Country:US
Practice Address - Phone:480-917-7800
Practice Address - Fax:480-917-8500
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT072310163W00000X
CT003315363LF0000X
AZRN146859163W00000X
AZAP2787363LF0000X
AZAZ2787363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ259932OtherAHCCCS
CT500001654Medicare ID - Type Unspecified
CT004257855Medicare ID - Type Unspecified
AZ259932OtherAHCCCS