Healthcare Provider Details

I. General information

NPI: 1528684446
Provider Name (Legal Business Name): HEIDI LOUISE WENDORF DNP, CNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 E 2ND ST
DULUTH MN
55805-2378
US

IV. Provider business mailing address

1401 EAST 1ST STREET
DULUTH MN
55805-2407
US

V. Phone/Fax

Practice location:
  • Phone: 218-728-4491
  • Fax: 218-728-7970
Mailing address:
  • Phone: 218-728-4491
  • Fax: 218-302-8698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number7563
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: