Provider Demographics
NPI:1750636213
Name:HOMBEL, WENDELL MACK I (LMP)
Entity Type:Individual
Prefix:MR
First Name:WENDELL
Middle Name:MACK
Last Name:HOMBEL
Suffix:I
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-5008
Mailing Address - Country:US
Mailing Address - Phone:509-953-0073
Mailing Address - Fax:
Practice Address - Street 1:205 E 9TH ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-5008
Practice Address - Country:US
Practice Address - Phone:509-953-0073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60117552175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath