Healthcare Provider Details

I. General information

NPI: 1750178455
Provider Name (Legal Business Name): WENDY JILL SANDONA NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 PLUM RD STE A
WRIGHTSTOWN WI
54180-7302
US

IV. Provider business mailing address

111 NORMAN LN
WRIGHTSTOWN WI
54180-1800
US

V. Phone/Fax

Practice location:
  • Phone: 920-819-0469
  • Fax:
Mailing address:
  • Phone: 920-819-0469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3814747
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: