Provider Demographics
NPI:1255334843
Name:WENDELKEN, DIANE FLORENCE (APRN)
Entity type:Individual
Prefix:MISS
First Name:DIANE
Middle Name:FLORENCE
Last Name:WENDELKEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 CHARLES PL
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2750
Mailing Address - Country:US
Mailing Address - Phone:785-776-1400
Mailing Address - Fax:785-776-7392
Practice Address - Street 1:1620 CHARLES PL
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2750
Practice Address - Country:US
Practice Address - Phone:785-776-1400
Practice Address - Fax:785-776-7392
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-45554363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200253940AMedicaid
MW1081479OtherDEA NUMBER
KS161209Medicare PIN
MW1081479OtherDEA NUMBER