Provider Demographics
NPI:1821816398
Name:FOOTE, WENDY (LPN)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:FOOTE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:WELLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:20801 CHARLESTOWN RD SW
Mailing Address - Street 2:
Mailing Address - City:LONACONING
Mailing Address - State:MD
Mailing Address - Zip Code:21539-1377
Mailing Address - Country:US
Mailing Address - Phone:912-323-8701
Mailing Address - Fax:
Practice Address - Street 1:14701 NATIONAL HWY SW STE 5&6
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-6573
Practice Address - Country:US
Practice Address - Phone:301-687-0940
Practice Address - Fax:301-687-0948
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV40409164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse