Provider Demographics
NPI:1407219108
Name:WENDT, REBECCA ALENE (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ALENE
Last Name:WENDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9320 GRAND CORDERA PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-7004
Mailing Address - Country:US
Mailing Address - Phone:719-282-6337
Mailing Address - Fax:
Practice Address - Street 1:9320 GRAND CORDERA PKWY STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-7004
Practice Address - Country:US
Practice Address - Phone:719-282-6337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0059110207Q00000X
COTL.0006182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine