Healthcare Provider Details

I. General information

NPI: 1972761955
Provider Name (Legal Business Name): MRS. WENDI WANNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 EASTON DR
BAKERSFIELD CA
93309-1021
US

IV. Provider business mailing address

PO BOX 13310
BAKERSFIELD CA
93389-3310
US

V. Phone/Fax

Practice location:
  • Phone: 661-377-1700
  • Fax: 661-377-1707
Mailing address:
  • Phone: 661-873-7975
  • Fax: 661-377-0295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT2328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: