Provider Demographics
NPI:1407624653
Name:WENDLER, KRISTINA (RN, CLS)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:WENDLER
Suffix:
Gender:F
Credentials:RN, CLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 CHAUNCEY CT
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1347
Mailing Address - Country:US
Mailing Address - Phone:574-202-6854
Mailing Address - Fax:
Practice Address - Street 1:10775 MCKINLEY HWY
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IN
Practice Address - Zip Code:46561-9163
Practice Address - Country:US
Practice Address - Phone:574-213-2102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28244932A163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant