=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366329500
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAITLYN JAN WENDT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2025
-----------------------------------------------------
Last Update Date | 08/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 HEALTHY WAY
-----------------------------------------------------
City | OLIVIA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56277-1117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-916-1836
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 37500 COUNTY ROAD 24
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56087-1605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-430-2461
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | 13247
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------