Healthcare Provider Details

I. General information

NPI: 1801847546
Provider Name (Legal Business Name): WENDI JOY LUNDQUIST D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 05/29/2023
Certification Date: 05/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15547 N REEMS RD BLDG A
SURPRISE AZ
85374-9583
US

IV. Provider business mailing address

15547 N REEMS RD BLDG A
SURPRISE AZ
85374-9583
US

V. Phone/Fax

Practice location:
  • Phone: 623-535-9777
  • Fax: 623-236-3179
Mailing address:
  • Phone: 623-535-9777
  • Fax: 623-236-3179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number4116
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number005097
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: