Provider Demographics
NPI:1679240071
Name:THORUP-PAVLICK, WENDY (NBC-HWC)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
Last Name:THORUP-PAVLICK
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3186 BENNETT PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-7064
Mailing Address - Country:US
Mailing Address - Phone:630-423-6101
Mailing Address - Fax:
Practice Address - Street 1:3186 BENNETT PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-7064
Practice Address - Country:US
Practice Address - Phone:630-423-6101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-3255796