Provider Demographics
NPI:1801998372
Name:HANSEN-PENMAN, WENDY M (DO)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:M
Last Name:HANSEN-PENMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:M
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1801 HICKMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-1597
Mailing Address - Country:US
Mailing Address - Phone:515-282-2200
Mailing Address - Fax:515-282-7823
Practice Address - Street 1:1801 HICKMAN ROAD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-1597
Practice Address - Country:US
Practice Address - Phone:515-282-2200
Practice Address - Fax:515-282-7823
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3733207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0498675Medicaid
IAI19321Medicare PIN
IA0498675Medicaid