Provider Demographics
NPI:1376201467
Name:ALSTON, WENDY JORDAN
Entity Type:Individual
Prefix:MISS
First Name:WENDY
Middle Name:JORDAN
Last Name:ALSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 BERRYHILL CIR APT 103
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-9124
Mailing Address - Country:US
Mailing Address - Phone:443-930-7720
Mailing Address - Fax:
Practice Address - Street 1:4807 BERRYHILL CIR
Practice Address - Street 2:
Practice Address - City:PERRY HALL
Practice Address - State:MD
Practice Address - Zip Code:21128-9229
Practice Address - Country:US
Practice Address - Phone:443-930-7720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy