Provider Demographics
NPI:1801847546
Name:LUNDQUIST, WENDI JOY (DO)
Entity Type:Individual
Prefix:DR
First Name:WENDI
Middle Name:JOY
Last Name:LUNDQUIST
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15547 N REEMS RD BLDG A
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-9583
Mailing Address - Country:US
Mailing Address - Phone:623-535-9777
Mailing Address - Fax:623-236-3179
Practice Address - Street 1:15547 N REEMS RD BLDG A
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-9583
Practice Address - Country:US
Practice Address - Phone:623-535-9777
Practice Address - Fax:623-236-3179
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV41162081P2900X
AZ0050972081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2663023Medicaid
WV3810005554Medicaid
AZ401924Medicaid
OH2663023Medicaid
AZZ129905Medicare PIN
WVI39747Medicare UPIN
AZ401924Medicaid