Healthcare Provider Details

I. General information

NPI: 1639824980
Provider Name (Legal Business Name): WENDY LYNN DUENAS PRSS-5102
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W 1ST ST
RENO NV
89503-5675
US

IV. Provider business mailing address

1706 SUE WAY
SPARKS NV
89431-1852
US

V. Phone/Fax

Practice location:
  • Phone: 775-322-8941
  • Fax: 775-322-1544
Mailing address:
  • Phone: 775-741-3134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRSS-5102
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: