Provider Demographics
NPI:1417927310
Name:WANDEL, AMY GERRIT (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:GERRIT
Last Name:WANDEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6383 GRANGERS DAIRY DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-1039
Mailing Address - Country:US
Mailing Address - Phone:619-301-4155
Mailing Address - Fax:
Practice Address - Street 1:2200 SUNRISE BLVD
Practice Address - Street 2:MERCY MEDICAL GROUP MERCY
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4374
Practice Address - Country:US
Practice Address - Phone:916-536-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAGS2862208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery