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NPI Code Detail

MEDICARE: REBECCA ALENE WENDT M.D.

MEDICARE: REBECCA ALENE WENDT M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianDR.0059110CO

General Provider Information

NPI Number : 1407219108
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA ALENE WENDT M.D.
Provider Business Mailing Address
First Line : 9320 GRAND CORDERA PKWY STE 100
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80924-7004
Country : US
Telephone Number : 719-282-6337
Fax Number :
Provider Business Practice Location Address
First Line : 9320 GRAND CORDERA PKWY STE 100
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80924-7004
Country : US
Telephone Number : 719-282-6337
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2016
Last Update Date : 03/29/2024

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