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General NPI Number Information
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NPI Number | 1336649854
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Entity Type | Individual
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Provider Name | WEN JUN WENDY SHI LAC
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Gender | Female
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Dates
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Enumeration Date | 02/21/2018
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Last Update Date | 04/24/2019
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Provider Practice Location Address
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Address Line | 690 S LOOP 336 W STE 240
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City | CONROE
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State | TX
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Zip | 77304-3320
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Country | US
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Telephone | 281-818-9996
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Fax |
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Provider Business Mailing Address
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Address Line | 12619 PEGASUS DR
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City | WILLIS
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State | TX
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Zip | 77318-5074
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC01290
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License Number State | TX
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