Provider Demographics
NPI:1417995580
Name:NEARY, WENDY (MD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:NEARY
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 1:2511 SW TRENTON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-3206
Mailing Address - Country:US
Mailing Address - Phone:206-763-5057
Mailing Address - Fax:206-763-5241
Practice Address - Street 1:2511 SW TRENTON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-3206
Practice Address - Country:US
Practice Address - Phone:206-763-5057
Practice Address - Fax:206-763-5241
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA310632OtherSTATE L&I
G8921260Medicare PIN
WAG50483Medicare UPIN