Provider Demographics
NPI:1649664400
Name:MEHAN, WENDY K (LPN)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:K
Last Name:MEHAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 161
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:MI
Mailing Address - Zip Code:49248-0161
Mailing Address - Country:US
Mailing Address - Phone:517-673-2670
Mailing Address - Fax:
Practice Address - Street 1:12245 TREAT HWY
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:MI
Practice Address - Zip Code:49248-9719
Practice Address - Country:US
Practice Address - Phone:517-673-2670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI47-03-076659164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse