Provider Demographics
NPI:1801011267
Name:WENDEL, RENATO (LIC AC)
Entity Type:Individual
Prefix:
First Name:RENATO
Middle Name:
Last Name:WENDEL
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 GRAVES RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:MA
Mailing Address - Zip Code:01341-9601
Mailing Address - Country:US
Mailing Address - Phone:413-369-4267
Mailing Address - Fax:
Practice Address - Street 1:PIONEER WHOLE HEALTH
Practice Address - Street 2:235 GREENFIELD ROAD - #7
Practice Address - City:SOUTH DEERFIELD
Practice Address - State:MA
Practice Address - Zip Code:01373
Practice Address - Country:US
Practice Address - Phone:413-369-4267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA314171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist