Provider Demographics
NPI:1932311057
Name:FALKINS, WENDY ANNE (NP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ANNE
Last Name:FALKINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:ANNE
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M510
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-7762
Mailing Address - Fax:269-341-8098
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M510
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-7762
Practice Address - Fax:269-341-8098
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704199743363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN54580014Medicare PIN