MEDICARE: MRS. ANNA NICOLE WENDEL FNP-C

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
1	363L00000X	Nurse Practitioner	AP142943	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2J6706	OTHER	TX	TEXAS MEDICARE
2	2J6711	OTHER	TX	TEXAS MEDICARE

General Provider Information

NPI Number	:	1437703675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNA NICOLE WENDEL FNP-C

Provider Business Mailing Address
First Line	:	101 W LOUIS HENNA BLVD STE 300
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78728-1203
Country	:	US
Telephone Number	:	512-244-4272
Fax Number	:	512-244-2895

Provider Business Practice Location Address
First Line	:	1106 COLLEGE ST STE C
Second Line	:
City	:	BASTROP
State	:	TX
Zip	:	78602-3948
Country	:	US
Telephone Number	:	512-244-4272
Fax Number	:	512-244-2895

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2019
Last Update Date	:	01/03/2024

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