Provider Demographics
NPI:1568447472
Name:MA, WENDY
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 HAMMOND AVE
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-9775
Mailing Address - Country:US
Mailing Address - Phone:253-968-1720
Mailing Address - Fax:253-968-1112
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER
Practice Address - Street 2:DEPT OF OB/GYN
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-6023
Practice Address - Fax:253-968-1112
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050738L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology