Provider Demographics
NPI:1780818062
Name:GUTWEIN, WENDY J (APRN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:J
Last Name:GUTWEIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4699
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-4699
Mailing Address - Country:US
Mailing Address - Phone:765-449-2732
Mailing Address - Fax:765-449-1196
Practice Address - Street 1:1345 UNITY PLACE
Practice Address - Street 2:SUITE 145A
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5771
Practice Address - Country:US
Practice Address - Phone:765-446-5040
Practice Address - Fax:765-446-5041
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28118752A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200141440Medicaid
INS51777Medicare UPIN
IN815150IIIIMedicare PIN