Healthcare Provider Details

I. General information

NPI: 1841289741
Provider Name (Legal Business Name): NANETTE KATHLEEN WENDEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 S WOODS MILL RD SUITE 200 EAST
CHESTERFIELD MO
63017-3417
US

IV. Provider business mailing address

232 S WOODS MILL RD SUITE 200 EAST
CHESTERFIELD MO
63017-3417
US

V. Phone/Fax

Practice location:
  • Phone: 314-205-6491
  • Fax: 314-205-6492
Mailing address:
  • Phone: 314-205-6491
  • Fax: 314-205-6492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME73308
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: