Provider Demographics
NPI:1942802822
Name:STREET, WENDY SUZANNE
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:SUZANNE
Last Name:STREET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 HEDGEPATH TER
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-3297
Mailing Address - Country:US
Mailing Address - Phone:336-870-1995
Mailing Address - Fax:
Practice Address - Street 1:869 HEDGEPATH TER
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-3297
Practice Address - Country:US
Practice Address - Phone:336-870-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC236374163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse