Provider Demographics
NPI:1770623589
Name:WENDT, CHERYL (CPNP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:WENDT
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5515 W MELVINA ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2220
Mailing Address - Country:US
Mailing Address - Phone:414-871-2590
Mailing Address - Fax:
Practice Address - Street 1:3040 N 117TH ST STE 100
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-4128
Practice Address - Country:US
Practice Address - Phone:414-479-9990
Practice Address - Fax:414-479-0230
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI589-033363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1770623589Medicaid
WIQ23876Medicare UPIN