Provider Demographics
NPI:1689683732
Name:WENDT, PEGGY A (CFM)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:A
Last Name:WENDT
Suffix:
Gender:F
Credentials:CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2434 FOREST MANOR CT
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-4825
Mailing Address - Country:US
Mailing Address - Phone:920-722-2139
Mailing Address - Fax:920-722-2139
Practice Address - Street 1:2434 FOREST MANOR CT
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-4825
Practice Address - Country:US
Practice Address - Phone:920-722-2139
Practice Address - Fax:920-722-2139
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
0295430002Medicare ID - Type Unspecified