Provider Demographics
NPI:1912039173
Name:WENDY DIMMETTE MD P C
Entity Type:Organization
Organization Name:WENDY DIMMETTE MD P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMMETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-425-3414
Mailing Address - Street 1:PO BOX 988
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-0988
Mailing Address - Country:US
Mailing Address - Phone:505-425-3414
Mailing Address - Fax:505-425-3616
Practice Address - Street 1:1235 8TH ST STE 700
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4219
Practice Address - Country:US
Practice Address - Phone:505-425-3414
Practice Address - Fax:505-425-3616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM962272084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty