Provider Demographics
NPI:1619286325
Name:WILLIAMS, WENDY LYNETTE (FNP-C)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LYNETTE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:LYNETTE
Other - Last Name:TULEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:428 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670-2004
Mailing Address - Country:US
Mailing Address - Phone:812-385-3589
Mailing Address - Fax:812-385-3616
Practice Address - Street 1:428 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-2004
Practice Address - Country:US
Practice Address - Phone:812-385-3589
Practice Address - Fax:812-385-3616
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003398A363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201009480Medicaid
IN81-4840406OtherIRS
IN300002156Medicaid