Healthcare Provider Details

I. General information

NPI: 1134153398
Provider Name (Legal Business Name): WESLEY R WEDNER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17888 W BIG LAKE BLVD
MOUNT VERNON WA
98274-8387
US

IV. Provider business mailing address

PO BOX 988
BURLINGTON WA
98233-0637
US

V. Phone/Fax

Practice location:
  • Phone: 360-734-6849
  • Fax:
Mailing address:
  • Phone: 360-734-6849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number08655
License Number StateWA

VIII. Authorized Official

Name: WES WEDNER
Title or Position: OWNER
Credential:
Phone: 360-661-2088