Provider Demographics
NPI:1811982374
Name:SPELLUN, WENDY (NP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:SPELLUN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DAVOL SQ
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4754
Mailing Address - Country:US
Mailing Address - Phone:401-421-4000
Mailing Address - Fax:401-272-1456
Practice Address - Street 1:900 WARREN AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1430
Practice Address - Country:US
Practice Address - Phone:800-508-4908
Practice Address - Fax:401-228-6236
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00540363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIWS08976Medicaid
RI406773OtherBLUE CHIP
RI709004155OtherMEDICARE GROUP
RI2849-7OtherBCBS OF RI
RI406773OtherBLUE CHIP
RI2849-7OtherBCBS OF RI
RI050483739OtherTIN #