Provider Demographics
NPI:1770595464
Name:WELTY, WENDY S (CRNA)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:S
Last Name:WELTY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:S
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:800 E 21ST ST
Mailing Address - Street 2:PAT FINANCIAL SERVICES
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1016
Mailing Address - Country:US
Mailing Address - Phone:605-322-2754
Mailing Address - Fax:605-322-2727
Practice Address - Street 1:800 E 21ST ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1016
Practice Address - Country:US
Practice Address - Phone:605-322-2754
Practice Address - Fax:605-322-2727
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR024281-0375367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN258683500Medicaid
SD460224743-57105-AE55OtherTRICARE
SD5751402Medicaid
NE460224743-48Medicaid
SD0003551OtherSD BLUE CROSS PROV #
IA1536607Medicaid
SDR024281OtherDAKOTACARE
MN013K5SCOtherMN BLUE CROSS PROVIDER #
SDS3551Medicare PIN
SD0003551OtherSD BLUE CROSS PROV #
SD430028124/CEO909Medicare PIN