Healthcare Provider Details

I. General information

NPI: 1821816398
Provider Name (Legal Business Name): WENDY FOOTE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WENDY WELLMAN LPN

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14701 NATIONAL HWY SW STE 5&6
LAVALE MD
21502-6573
US

IV. Provider business mailing address

20801 CHARLESTOWN RD SW
LONACONING MD
21539-1377
US

V. Phone/Fax

Practice location:
  • Phone: 301-687-0940
  • Fax: 301-687-0948
Mailing address:
  • Phone: 912-323-8701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number40409
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: