Provider Demographics
NPI:1477658961
Name:WANLASS, WENDY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:ANN
Last Name:WANLASS
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:PO BOX 1035
Mailing Address - Street 2:VETERANS ADMINISTRATION
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97207
Mailing Address - Country:US
Mailing Address - Phone:503-220-8262
Mailing Address - Fax:360-737-1426
Practice Address - Street 1:1603 FOURTH PLAIN BLVD
Practice Address - Street 2:VA MEDICAL CENTER NSCU
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661
Practice Address - Country:US
Practice Address - Phone:803-220-8262
Practice Address - Fax:360-737-1426
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035429207RG0300X
ORMD12642207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine