Provider Demographics
NPI:1629753850
Name:WENDT, ZACHARY JACOB
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:JACOB
Last Name:WENDT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3936 GEORGE RD
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54495-9371
Mailing Address - Country:US
Mailing Address - Phone:715-451-9994
Mailing Address - Fax:
Practice Address - Street 1:750 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2221
Practice Address - Country:US
Practice Address - Phone:608-263-5621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program