Provider Demographics
NPI:1700374923
Name:FLETT, WENDY MARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:MARIE
Last Name:FLETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:WENDY
Other - Middle Name:MARIE
Other - Last Name:FLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2522 8TH ST
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-4122
Mailing Address - Country:US
Mailing Address - Phone:503-815-8095
Mailing Address - Fax:
Practice Address - Street 1:610 STILLWELL AVE
Practice Address - Street 2:
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-3752
Practice Address - Country:US
Practice Address - Phone:503-842-9622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201505495RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty