Healthcare Provider Details

I. General information

NPI: 1285880864
Provider Name (Legal Business Name): WENDY ANN PLOEGSTRA APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10820 N TORREY PINES RD
LA JOLLA CA
92037-1036
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-3330
  • Fax:
Mailing address:
  • Phone: 858-554-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95028069
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209007160
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: