Provider Demographics
NPI:1184764409
Name:STEPHENS, WENDY CAROLE CUDIO (MD)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:CAROLE CUDIO
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 3RD AVE E
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-1573
Mailing Address - Country:US
Mailing Address - Phone:320-762-2311
Mailing Address - Fax:320-762-8942
Practice Address - Street 1:418 3RD AVE E
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-1573
Practice Address - Country:US
Practice Address - Phone:320-762-2311
Practice Address - Fax:320-762-8942
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39436207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0112547OtherMEDICA
MN344111014835OtherPREFERRED ONE
MN018LISTOtherBCBS
MN018L2STOtherBCBS
G40640Medicare UPIN
MN344111014835OtherPREFERRED ONE