Provider Demographics
NPI:1912004896
Name:BRANDON, WENDY JEAN (NP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:JEAN
Last Name:BRANDON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 CENTRAL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-3667
Mailing Address - Country:US
Mailing Address - Phone:707-445-4705
Mailing Address - Fax:707-445-0581
Practice Address - Street 1:1836 CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-3667
Practice Address - Country:US
Practice Address - Phone:707-445-4705
Practice Address - Fax:707-445-0581
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15707363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health