Healthcare Provider Details

I. General information

NPI: 1043201601
Provider Name (Legal Business Name): WENDY SUE PACA RN, MSN, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WENDY SUE KLESEL

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 BANK ST
WEBSTER CITY IA
50595-2204
US

IV. Provider business mailing address

510 BANK ST
WEBSTER CITY IA
50595-2204
US

V. Phone/Fax

Practice location:
  • Phone: 515-832-6700
  • Fax: 515-832-3534
Mailing address:
  • Phone: 515-832-6700
  • Fax: 515-832-3534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberJ-090609
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: