Provider Demographics
NPI:1922166149
Name:STEDEFORD, WENDY ELIZABETH (LAC)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:ELIZABETH
Last Name:STEDEFORD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:907 EMBARCADERO DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4087
Mailing Address - Country:US
Mailing Address - Phone:916-933-1221
Mailing Address - Fax:916-933-0871
Practice Address - Street 1:907 EMBARCADERO DR
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4087
Practice Address - Country:US
Practice Address - Phone:916-933-1221
Practice Address - Fax:916-933-0871
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9099207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine