Provider Demographics
NPI:1811603806
Name:WENDEL, JEREMY KEITH (RN)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:KEITH
Last Name:WENDEL
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 HAZEL TREE CT
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1799
Mailing Address - Country:US
Mailing Address - Phone:469-939-6833
Mailing Address - Fax:
Practice Address - Street 1:3309 HAZEL TREE CT
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-1799
Practice Address - Country:US
Practice Address - Phone:469-939-6833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001313743163W00000X
VA0024192249367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse