Provider Demographics
NPI:1740406990
Name:NYGAARD, WENDY JO (ATC, CSCS)
Entity Type:Individual
Prefix:MISS
First Name:WENDY
Middle Name:JO
Last Name:NYGAARD
Suffix:
Gender:F
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16461 169TH ST SE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-2903
Mailing Address - Country:US
Mailing Address - Phone:425-246-2720
Mailing Address - Fax:
Practice Address - Street 1:29000 NE 150TH ST
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-8519
Practice Address - Country:US
Practice Address - Phone:425-844-4872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer