Provider Demographics
NPI:1336862960
Name:WENDELL, SARA JANE
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JANE
Last Name:WENDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 LONE OAK RD
Mailing Address - Street 2:
Mailing Address - City:COTTAGEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25239-9092
Mailing Address - Country:US
Mailing Address - Phone:304-786-4417
Mailing Address - Fax:
Practice Address - Street 1:402 LONE OAK RD
Practice Address - Street 2:
Practice Address - City:COTTAGEVILLE
Practice Address - State:WV
Practice Address - Zip Code:25239-9092
Practice Address - Country:US
Practice Address - Phone:304-786-4417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant