Provider Demographics
NPI:1275804197
Name:VANDYKE, WENDY (GNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:
Last Name:VANDYKE
Suffix:
Gender:F
Credentials:GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 NE LOOP 410 STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5650
Mailing Address - Country:US
Mailing Address - Phone:210-599-6000
Mailing Address - Fax:210-657-5586
Practice Address - Street 1:2455 NE LOOP 410 STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5650
Practice Address - Country:US
Practice Address - Phone:210-599-6000
Practice Address - Fax:210-657-5586
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX667620363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP119635OtherLICENSE