Provider Demographics
NPI:1831418243
Name:WENDT, LORIE R (NP-C)
Entity type:Individual
Prefix:
First Name:LORIE
Middle Name:R
Last Name:WENDT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 SANDHUTTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-8087
Mailing Address - Country:US
Mailing Address - Phone:815-566-2052
Mailing Address - Fax:779-888-8084
Practice Address - Street 1:2323 SANDHUTTON AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-8087
Practice Address - Country:US
Practice Address - Phone:815-566-2052
Practice Address - Fax:779-888-8084
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277001432363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health