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General NPI Number Information
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NPI Number | 1326455643
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Entity Type | Organization
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Legal Business Name | WENDEL COMMUNITY CLINIC PLLC
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Dates
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Enumeration Date | 07/18/2014
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Last Update Date | 02/17/2015
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Provider Practice Location Address
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Address Line | 1103 FM 2558
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City | BROADDUS
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State | TX
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Zip | 75929-3777
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Country | US
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Telephone | 936-872-1077
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Fax |
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Provider Business Mailing Address
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Address Line | 1103 FM 2558
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City | BROADDUS
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State | TX
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Zip | 75929-3777
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Country | US
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Telephone | 936-872-1077
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEBRA LYNN WENDEL
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Credential | FNP
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Telephone | 936-872-1077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 634541
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License Number State | TX
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