Provider Demographics
NPI:1952471146
Name:MARLOW, WENDY L (PA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:L
Last Name:MARLOW
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1900 RANDOLPH RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1122
Mailing Address - Country:US
Mailing Address - Phone:704-384-9113
Mailing Address - Fax:704-316-0508
Practice Address - Street 1:8810 BLAKENEY PROFESSIONAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6595
Practice Address - Country:US
Practice Address - Phone:704-759-8188
Practice Address - Fax:704-759-0857
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
NC102387363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCML0298388OtherDEA LICENSE