Provider Demographics
NPI:1407970932
Name:WENDT, NINA ELAINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:ELAINE
Last Name:WENDT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 S SANTA CLAUS LN
Mailing Address - Street 2:UNIT 2
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-7702
Mailing Address - Country:US
Mailing Address - Phone:907-488-8848
Mailing Address - Fax:907-488-0695
Practice Address - Street 1:145 S SANTA CLAUS LN
Practice Address - Street 2:UNIT 2
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-7702
Practice Address - Country:US
Practice Address - Phone:907-488-8848
Practice Address - Fax:907-488-0695
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT311103TC0700X
AK610103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000050107Medicare ID - Type Unspecified