Healthcare Provider Details

I. General information

NPI: 1659920825
Provider Name (Legal Business Name): WENDY VORTHERMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 MONTAUBON CT
NAPLES FL
34112-7148
US

IV. Provider business mailing address

4840 2ND AVE SE
NAPLES FL
34117-9041
US

V. Phone/Fax

Practice location:
  • Phone: 239-821-5536
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: