Provider Demographics
NPI:1811620305
Name:WENDORFF, ADAM JOHN (APRNCNP)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JOHN
Last Name:WENDORFF
Suffix:
Gender:M
Credentials:APRNCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19729 PARKMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-1767
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18101 LORAIN AVE
Practice Address - Street 2:4 PAVILION - CHILD & ADOLESCENT PSYCHIATRY
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5612
Practice Address - Country:US
Practice Address - Phone:216-476-6958
Practice Address - Fax:216-476-4845
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-02
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHBEINGREVIEWED1363LP0808X
OHPROCESSING363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAPRN.CNP.0031707OtherAPRN LICENSE NUMBER