Provider Demographics
NPI:1619283769
Name:WENDELL, LORI JANE (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:JANE
Last Name:WENDELL
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:JANE
Other - Last Name:MULLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:206 CHASE PARK
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526
Mailing Address - Country:US
Mailing Address - Phone:304-382-2080
Mailing Address - Fax:304-404-2057
Practice Address - Street 1:206 CHASE PARK
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526
Practice Address - Country:US
Practice Address - Phone:304-382-2080
Practice Address - Fax:304-404-2057
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV37430363LF0000X
WVAPRN37430363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP01087432OtherMEDICARE RAILROAD
WV3810020023Medicaid
WVWV1472AMedicare PIN