Healthcare Provider Details

I. General information

NPI: 1366270431
Provider Name (Legal Business Name): WENDY MARIE WILLIS RN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WILLOW RD
CODY WY
82414-8227
US

IV. Provider business mailing address

10 WILLOW RD
CODY WY
82414-8227
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone: 307-272-6230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number57402
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number21116
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: