Provider Demographics
NPI:1841583739
Name:KING, WENDY KAY
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:KAY
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 S. PINE GROVE ROAD
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48888
Mailing Address - Country:US
Mailing Address - Phone:616-214-9893
Mailing Address - Fax:
Practice Address - Street 1:251 S. PINE GROVE ROAD
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:MI
Practice Address - Zip Code:48888
Practice Address - Country:US
Practice Address - Phone:616-214-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704273680163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse