Provider Demographics
NPI:1679328942
Name:WENDT, MICHELLE L (RN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:WENDT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N10231 ASHLEY RD
Mailing Address - Street 2:
Mailing Address - City:SHIOCTON
Mailing Address - State:WI
Mailing Address - Zip Code:54170-9404
Mailing Address - Country:US
Mailing Address - Phone:715-584-7897
Mailing Address - Fax:
Practice Address - Street 1:916 S 10TH ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-6502
Practice Address - Country:US
Practice Address - Phone:715-584-7897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI157820163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse