Provider Demographics
NPI:1356698153
Name:CREGG, WENDY (NP-C)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:CREGG
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:HOVLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:875 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-1081
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:401-652-9119
Practice Address - Street 1:875 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1081
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:401-652-9119
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP 0756363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily