Provider Demographics
NPI:1972837680
Name:WENDT, LAURA BETH (ANP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:WENDT
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949 GUNBARREL RD STE 206
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3188
Mailing Address - Country:US
Mailing Address - Phone:423-495-4345
Mailing Address - Fax:423-495-4934
Practice Address - Street 1:605 GLENWOOD DR
Practice Address - Street 2:SUITE 404
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1175
Practice Address - Country:US
Practice Address - Phone:423-629-7220
Practice Address - Fax:423-629-4091
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNANP14428363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health