Provider Demographics
NPI:1891578027
Name:PIERCE, WENDY ANN
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:ANN
Last Name:PIERCE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:WENDY
Other - Middle Name:ANN
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 W CERMAK RD STE 3D
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2268
Mailing Address - Country:US
Mailing Address - Phone:312-427-6000
Mailing Address - Fax:312-427-6004
Practice Address - Street 1:600 W CERMAK RD STE 3D
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2268
Practice Address - Country:US
Practice Address - Phone:312-427-6000
Practice Address - Fax:312-427-6004
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209028322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily