Healthcare Provider Details

I. General information

NPI: 1437178779
Provider Name (Legal Business Name): MARY JO WENDLING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 PLAZA DR SUITE 2200
WAUSAU WI
54401-4158
US

IV. Provider business mailing address

3000 WESTHILL DR SUITE 303
WAUSAU WI
54401-3795
US

V. Phone/Fax

Practice location:
  • Phone: 715-847-2311
  • Fax:
Mailing address:
  • Phone: 715-847-2304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number44203
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: