Provider Demographics
NPI:1023079159
Name:DAVIDSON, WENDI ALANE (NP)
Entity type:Individual
Prefix:MR
First Name:WENDI
Middle Name:ALANE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:245 STATE ST SE
Mailing Address - Street 2:STE 221
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503
Mailing Address - Country:US
Mailing Address - Phone:616-685-1808
Mailing Address - Fax:616-685-1850
Practice Address - Street 1:200 JEFFERSON SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:616-685-5000
Practice Address - Fax:616-685-3084
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2009-09-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704146324163WN0002X, 363LN0005X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care