Provider Demographics
NPI:1881226876
Name:PAPPAS, WENDY
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:
Last Name:PAPPAS
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 1:67567 SPAID RD
Mailing Address - Street 2:
Mailing Address - City:BURR OAK
Mailing Address - State:MI
Mailing Address - Zip Code:49030-9788
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:67567 SPAID RD
Practice Address - Street 2:
Practice Address - City:BURR OAK
Practice Address - State:MI
Practice Address - Zip Code:49030-9788
Practice Address - Country:US
Practice Address - Phone:269-503-0196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703099988164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse