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General NPI Number Information
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NPI Number | 1912039173
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Entity Type | Organization
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Legal Business Name | WENDY DIMMETTE MD P C
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1235 8TH ST STE 700
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City | LAS VEGAS
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State | NM
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Zip | 87701-4219
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Country | US
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Telephone | 505-425-3414
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Fax | 505-425-3616
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Provider Business Mailing Address
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Address Line | PO BOX 988
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City | LAS VEGAS
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State | NM
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Zip | 87701-0988
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Country | US
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Telephone | 505-425-3414
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Fax | 505-425-3616
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Authorized Official
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Title or Position | OWNER
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Name | DR. WENDY DIMMETTE
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Credential | M.D.
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Telephone | 505-425-3414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | NM96227
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License Number State | NM
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